title: Methylprednisolone, cortisol and the cell-mediated immune response in children after ventricular septal defect repair.
abstract: BACKGROUND
  This study evaluated the effects of methylprednisolone on cortisol and cell-mediated immune response (T-lymphocytes and HLA-DR+ monocytes) in peripheral blood after open-heart surgery with cardiopulmonary bypass (CPB) for ventricular septal defect.
  
  
  METHODS
  A prospective observational study was carried out in a tertiary multidisciplinary neonatal and paediatric intensive care unit. Ten children under 2 years of age received methylprednisolone succinate (30 mg/kg body weight) in CPB priming solutions before the CPB system was connected to the patient during surgery. Before and immediately after and at 24 and 96 h after the operation, T-lymphocytes and HLA-DR+ monocytes were measured by flow cytometry, and methylprednisolone, methylprednisolone succinate and cortisol in blood plasma were assayed by liquid chromatography-mass spectrometry.
  
  
  RESULTS
  The children were divided into groups with normal cardiac index (CI) and low CI. No significant differences in methylprednisolone and cortisol concentrations before and after surgery were found between the two groups. The normal CI group exhibited more than a three-fold decrease in T-lymphocytes 24 h after surgery and a two-fold decrease in HLA-DR+ monocyte fluorescence immediately after surgery.
  
  
  CONCLUSIONS
  Children with normal and low CI were differentiated by T-lymphocytes and HLA-DR+ monocytes. Since no differences in methylprednisolone exposure and cortisol plasma levels between the low-CI and normal-CI groups were found, it can be concluded that factors other than methylprednisolone must contribute to differences in the cell-mediated response.
authors.affiliation: Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, Slovenia. stefan.grosek@mf.uni-lj.si
authors.forename: Stefan
authors.initials: S
authors.lastname: Grosek
authors.forename: Alojz
authors.initials: A
authors.lastname: Ihan
authors.forename: Branka
authors.initials: B
authors.lastname: Wraber
authors.forename: Tone
authors.initials: T
authors.lastname: Gabrijelcic
authors.forename: Miro
authors.initials: M
authors.lastname: Kosin
authors.forename: Josko
authors.initials: J
authors.lastname: Osredkar
authors.forename: Günter
authors.initials: G
authors.lastname: Gmeiner
authors.forename: Iztok
authors.initials: I
authors.lastname: Grabnar
authors.forename: Janez
authors.initials: J
authors.lastname: Primozic
mesh_terms: D006348:Cardiac Surgical Procedures; D002853:Chromatography, Liquid; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000276:immunology / Q000378:metabolism; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007111:Immunity, Cellular / Q000276:immunology* / Q000502:physiology; D007223:Infant; D008297:Male; D013058:Mass Spectrometry; D008775:Methylprednisolone / Q000097:blood*; D009000:Monocytes / Q000276:immunology* / Q000378:metabolism; D013601:T-Lymphocytes / Q000276:immunology / Q000378:metabolism
chemical_list: D006684:HLA-DR Antigens; D006854:Hydrocortisone; D008775:Methylprednisolone