Effects of N-acetylcysteine on renal dysfunction in neonates undergoing the arterial switch operation.
OBJECTIVE
We evaluated N-acetylcysteine, a potent antioxidant, as prevention for renal dysfunction in infants undergoing cardiac surgery for dextro-transposition of the great arteries.


METHODS
Twenty-one neonates undergoing the arterial switch operation were randomized to receive either placebo or intravenous N-acetylcysteine. Serial data were collected on fluid balance, serum creatinine, inotropic support, cardiac output, and length of stay.


RESULTS
Hospital and 30-day survival was 100%. No serious adverse events were attributable to the drug. Subjects treated with N-acetylcysteine had a higher urine output at 24 hours (175 mL vs 96 mL; P < .01) and a shorter median time to first negative fluid balance (27 hours vs 39.5 hours; P = .02). There were no differences between groups in diuretic therapy, inotropic support, fluid intake, or chest tube output. Serum creatinine increased at 24 hours after the operation by a mean of 0.27 mg/dL with placebo (P < .01) but was unchanged with N-acetylcysteine treatment. By postoperative day 3, serum creatinine increased by 92% in the placebo group but only 38% in the N-acetylcysteine group (P = .04). Length of intensive care unit stay was shorter by an average of 5 days (P = .04) with N-acetylcysteine treatment.


CONCLUSIONS
In this pilot study, perioperative treatment with N-acetylcysteine resulted in improved urine output, shorter time to negative fluid balance, and attenuation of the rise in creatinine. These effects of N-acetylcysteine may translate to improved outcomes for infants undergoing complex cardiac operations.
Aiyagari
Ranjit
R
Division of Pediatric Cardiology, University of Michigan Medical School, L1242 Women's/SPC 5204, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5204, USA. ranjita@umich.edu
Gelehrter
Sarah
S
Bove
Edward L
EL
Ohye
Richard G
RG
Devaney
Eric J
EJ
Hirsch
Jennifer C
JC
Gurney
James G
JG
Charpie
John R
JR
D000111:Acetylcysteine / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D010865:Pilot Projects; D014188:Transposition of Great Vessels / Q000601:surgery*
D000975:Antioxidants; D000111:Acetylcysteine