Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery

Results from a randomized trial

Eric M. Graham, Andrew M. Atz, Ryan J. Butts, Nathaniel L. Baker, Sinai C. Zyblewski, Rachael L. Deardorff, Stacia M. Desantis, Scott T. Reeves, Scott M. Bradley, Francis G. Spinale

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objective: A heightened inflammatory response occurs after cardiac surgery. The perioperative use of glucocorticoids has been advocated as a method to improve postoperative outcomes. Randomized prospective studies to quantify the effect of methylprednisolone on perioperative outcomes in neonatal cardiac surgery have not been performed. We sought to determine whether preoperative methylprednisolone would improve postoperative recovery in neonates requiring cardiac surgery. Methods: Neonates scheduled for cardiac surgery were randomly assigned to receive either 2-dose (8 hours preoperatively and operatively, n = 39) or single-dose (operatively, n = 37) methylprednisolone (30 mg/kg per dose) in a prospective double-blind trial. The primary outcome was the incidence of low cardiac output syndrome (standardized score) or death 36 hours postoperatively. Secondary outcomes were death at 30 days, interleukin-6 levels, inotropic score, fluid balance, serum creatinine, and intensive care unit and hospital stay. Results: Preoperative plasma levels of the inflammatory cytokine interleukin-6 were reduced by 2-fold (P < .001) in the 2-dose methylprednisolone group, consistent with the anti-inflammatory effects of methylprednisolone. However, the incidence of low cardiac output syndrome was 46% (17/37) in the single-dose and 38% (15/39) in the 2-dose methylprednisolone groups (P = .51). Two-dose methylprednisolone was associated with a higher serum creatinine (0.61 ± 0.18 mg/dL vs 0.53 ± 0.12 mg/dL, P = .03) and poorer postoperative diuresis (-96 ± 49 mL, P = .05). Inotropic requirement, duration of mechanical ventilation, intensive care unit, and hospital stay did not differ between the 2 groups. Conclusions: Combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes and may exacerbate perioperative renal dysfunction.

Original languageEnglish (US)
Pages (from-to)1523-1529
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number6
DOIs
StatePublished - Dec 1 2011

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Methylprednisolone
Thoracic Surgery
Adrenal Cortex Hormones
Low Cardiac Output
Therapeutics
Glucocorticoids
Intensive Care Units
Interleukin-6
Length of Stay
Creatinine
Water-Electrolyte Balance
Diuresis
Incidence
Serum
Artificial Respiration
Anti-Inflammatory Agents
Prospective Studies
Cytokines
Kidney

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery : Results from a randomized trial. / Graham, Eric M.; Atz, Andrew M.; Butts, Ryan J.; Baker, Nathaniel L.; Zyblewski, Sinai C.; Deardorff, Rachael L.; Desantis, Stacia M.; Reeves, Scott T.; Bradley, Scott M.; Spinale, Francis G.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 6, 01.12.2011, p. 1523-1529.

Research output: Contribution to journalArticle

Graham, EM, Atz, AM, Butts, RJ, Baker, NL, Zyblewski, SC, Deardorff, RL, Desantis, SM, Reeves, ST, Bradley, SM & Spinale, FG 2011, 'Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: Results from a randomized trial', Journal of Thoracic and Cardiovascular Surgery, vol. 142, no. 6, pp. 1523-1529. https://doi.org/10.1016/j.jtcvs.2011.04.019
Graham, Eric M. ; Atz, Andrew M. ; Butts, Ryan J. ; Baker, Nathaniel L. ; Zyblewski, Sinai C. ; Deardorff, Rachael L. ; Desantis, Stacia M. ; Reeves, Scott T. ; Bradley, Scott M. ; Spinale, Francis G. / Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery : Results from a randomized trial. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 6. pp. 1523-1529.
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abstract = "Objective: A heightened inflammatory response occurs after cardiac surgery. The perioperative use of glucocorticoids has been advocated as a method to improve postoperative outcomes. Randomized prospective studies to quantify the effect of methylprednisolone on perioperative outcomes in neonatal cardiac surgery have not been performed. We sought to determine whether preoperative methylprednisolone would improve postoperative recovery in neonates requiring cardiac surgery. Methods: Neonates scheduled for cardiac surgery were randomly assigned to receive either 2-dose (8 hours preoperatively and operatively, n = 39) or single-dose (operatively, n = 37) methylprednisolone (30 mg/kg per dose) in a prospective double-blind trial. The primary outcome was the incidence of low cardiac output syndrome (standardized score) or death 36 hours postoperatively. Secondary outcomes were death at 30 days, interleukin-6 levels, inotropic score, fluid balance, serum creatinine, and intensive care unit and hospital stay. Results: Preoperative plasma levels of the inflammatory cytokine interleukin-6 were reduced by 2-fold (P < .001) in the 2-dose methylprednisolone group, consistent with the anti-inflammatory effects of methylprednisolone. However, the incidence of low cardiac output syndrome was 46{\%} (17/37) in the single-dose and 38{\%} (15/39) in the 2-dose methylprednisolone groups (P = .51). Two-dose methylprednisolone was associated with a higher serum creatinine (0.61 ± 0.18 mg/dL vs 0.53 ± 0.12 mg/dL, P = .03) and poorer postoperative diuresis (-96 ± 49 mL, P = .05). Inotropic requirement, duration of mechanical ventilation, intensive care unit, and hospital stay did not differ between the 2 groups. Conclusions: Combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes and may exacerbate perioperative renal dysfunction.",
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T2 - Results from a randomized trial

AU - Graham, Eric M.

AU - Atz, Andrew M.

AU - Butts, Ryan J.

AU - Baker, Nathaniel L.

AU - Zyblewski, Sinai C.

AU - Deardorff, Rachael L.

AU - Desantis, Stacia M.

AU - Reeves, Scott T.

AU - Bradley, Scott M.

AU - Spinale, Francis G.

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N2 - Objective: A heightened inflammatory response occurs after cardiac surgery. The perioperative use of glucocorticoids has been advocated as a method to improve postoperative outcomes. Randomized prospective studies to quantify the effect of methylprednisolone on perioperative outcomes in neonatal cardiac surgery have not been performed. We sought to determine whether preoperative methylprednisolone would improve postoperative recovery in neonates requiring cardiac surgery. Methods: Neonates scheduled for cardiac surgery were randomly assigned to receive either 2-dose (8 hours preoperatively and operatively, n = 39) or single-dose (operatively, n = 37) methylprednisolone (30 mg/kg per dose) in a prospective double-blind trial. The primary outcome was the incidence of low cardiac output syndrome (standardized score) or death 36 hours postoperatively. Secondary outcomes were death at 30 days, interleukin-6 levels, inotropic score, fluid balance, serum creatinine, and intensive care unit and hospital stay. Results: Preoperative plasma levels of the inflammatory cytokine interleukin-6 were reduced by 2-fold (P < .001) in the 2-dose methylprednisolone group, consistent with the anti-inflammatory effects of methylprednisolone. However, the incidence of low cardiac output syndrome was 46% (17/37) in the single-dose and 38% (15/39) in the 2-dose methylprednisolone groups (P = .51). Two-dose methylprednisolone was associated with a higher serum creatinine (0.61 ± 0.18 mg/dL vs 0.53 ± 0.12 mg/dL, P = .03) and poorer postoperative diuresis (-96 ± 49 mL, P = .05). Inotropic requirement, duration of mechanical ventilation, intensive care unit, and hospital stay did not differ between the 2 groups. Conclusions: Combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes and may exacerbate perioperative renal dysfunction.

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