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document
Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery : results from a randomized trial . 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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Intervention_Pharmacological
corticosteroid
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Intervention_Pharmacological
methylprednisolone
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Outcome_Physical
incidence of low cardiac output syndrome
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Outcome_Mortality
death at 30 days
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Outcome_Physical
interleukin-6 levels , inotropic score , fluid balance , serum creatinine
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Outcome_Other
intensive care unit and hospital stay
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Outcome_Physical
Preoperative plasma levels
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Outcome_Physical
the inflammatory cytokine interleukin-6
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Outcome_Physical
serum creatinine
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Outcome_Physical
postoperative
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Participant_Condition
neonates undergoing cardiac surgery :
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Participant_Condition
Neonates scheduled for cardiac surgery were randomly assigned to receive