Abstract 10816: Preoperative Steroid Treatment Does Not Improve Markers of Inflammation or Outcomes Following Cardiac Surgery in Neonates
Background: A heightened inflammatory response occurs following cardiac surgery and may contribute to post-operative morbidity, including low cardiac output syndrome (LCOS). Perioperative use of glucocorticoids, such as methylprednisolone (MP), has been advocated as a method to reduce inflammation and improve outcomes. However, no study to date has quantified the effects of MP on post-operative inflammatory response and LCOS in neonatal cardiac surgery. This study tested the hypothesis that preoperative MP followed by intraoperative MP (Two Dose MP), as compared to intraoperative MP alone (Single Dose MP), would differentially modify markers of inflammation and LCOS in neonates undergoing cardiac surgery.
Methods: Neonates (n=76) scheduled for cardiac surgery were entered into a blinded, randomized study in which either Two Dose MP (30mg/kg 8 hours preoperatively and 30 mg/kg intraoperatively; n=39) or Single Dose MP (30 mg/kg intraoperatively, n=37) was used. LCOS and serial cytokine levels were determined.
Results: Preoperative (prior to MP treatment) plasma IL-6 (27±15 pg/mL) and TNF (6.1±0.3 pg/mL) were similar between groups. These values fell by over 50% in the Two Dose MP group immediately prior to surgery (both p<0.05), consistent with a pharmacological effect of the preoperative MP dose. Postoperative levels of IL-6 demonstrated a robust increase in both groups (Figure). Postoperative levels of TNF were actually higher in the Two Dose MP group. Finally, the relative risk for LCOS was unaffected in the Two Dose MP group (0.78; 0.45-1.33; 95% confidence interval).
Conclusions: This prospective randomized study failed to demonstrate protective effects of combined preoperative and intraoperative glucocorticoids in neonatal cardiac surgery with respect to postoperative inflammation or recovery. These unique results suggest that the empirical use of preoperative glucocorticoids in the setting of neonatal cardiac surgery warrant re-evaluation.
- © 2010 by American Heart Association, Inc.