Abstract 16918: Low Cortisol Does Not Affect Post Operative Course after Norwood 1 Surgery for Single Ventricle Palliation
Title: Low Cortisol Does Not Affect Post Operative Course After Stage 1 Surgical Palliation (S1P) For Hypoplastic Left Heart (HLHS)
Objectives: The post-operative cortisol profile, and its association with early outcomes have not been explored in neonates undergoing surgery for complex congenital heart disease. We investigated the post-operative profile of cortisol, and its relationship with the peri-operative course in a cohort of newborns after S1P for HLHS.
Methods: Twenty-three infants with HLHS who underwent S1P between 2009 and 2011 had serial cortisol levels measured immediately upon return to the cardiovascular intensive care unit (CVICU), and on the next two post-operative mornings. None of the infants received systemic steroids during the first 72 hours after surgery, and all received intra-operative methylprednisolone.
Results are expressed as Median (IQR) or mean ± SD as appropriate.
Results: The median weight of the infants was 3.1 (2.7-3.3) kg, and age at surgery was 7.7 (6.4-8.7) days. The median cortisol levels on admission, day 1 and day 2 were 72.1(51.9 - 97.01), 26.3 (4.1 - 123.8) and 31.3 (2.5 -156.0) mcg/dl respectively (P<0.0001 between admission and day 1). Post-operative cortisol was higher in infants who had required pre-operative inotropes compared to those who did not (93.1± 16.3 mcg/dl vs 69.2 ± 25.4mcg/dl P=0.05). Nine infants (39%) met criteria for hypocortisolism (<7mcg/dl). Mean length of CVICU stay in infants with hypocortisolism was 13 ± 6 days vs 29 ± 36 days in those with normal level (p=0.09). There was no association between post-operative cortisol and the need for pre-operative ventilation, the duration of ventilation or duration of inotropic support.
Conclusions: Cortisol levels fell significantly over the first 24 hours after S1P for HLHS, and post-operative hypocortisolism was common in these infants. However, the cortisol level in this population did not appear to predict early post-operative CVICU outcome, though the association between a higher cortisol and the need for pre-operative inotropes warrants further investigation.
- Pediatric cardiac intensive care
- Structural heart disease intervention
- Single ventricle
- Shock, cardiogenic
- Pediatric cardiology
- © 2012 by American Heart Association, Inc.