title: Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: results from a randomized trial.
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.
authors: Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. grahamem@musc.edu
authors: Eric M
authors: EM
authors: Graham
authors: Andrew M
authors: AM
authors: Atz
authors: Ryan J
authors: RJ
authors: Butts
authors: Nathaniel L
authors: NL
authors: Baker
authors: Sinai C
authors: SC
authors: Zyblewski
authors: Rachael L
authors: RL
authors: Deardorff
authors: Stacia M
authors: SM
authors: DeSantis
authors: Scott T
authors: ST
authors: Reeves
authors: Scott M
authors: SM
authors: Bradley
authors: Francis G
authors: FG
authors: Spinale
references: Control Clin Trials. 1982 Dec;3(4):311-23
references: 7160189
references: Br J Surg. 2008 Jan;95(1):50-6
references: 18027383
references: Pediatr Crit Care Med. 2005 Jul;6(4):441-4
references: 15982431
references: N Engl J Med. 2007 Feb 15;356(7):663-75
references: 17301297
references: Eur J Pediatr. 1999 May;158(5):387-93
references: 10333121
references: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005550
references: 17943866
references: N Engl J Med. 2010 May 27;362(21):1980-92
references: 20505177
references: Circulation. 2003 Jun 10;107(22):2823-8
references: 12756159
references: Circulation. 2003 Feb 25;107(7):996-1002
references: 12600913
references: Stat Med. 2005 Sep 30;24(18):2747-64
references: 16134130
references: J Thorac Cardiovasc Surg. 1999 Mar;117(3):515-22
references: 10047655
references: Ann Thorac Surg. 2000 May;69(5):1490-5
references: 10881828
references: Cytometry B Clin Cytom. 2003 Jul;54(1):54-7
references: 12827668
references: Pediatr Crit Care Med. 2009 May;10(3):341-5
references: 19325509
references: Pediatr Cardiol. 2002 Jul-Aug;23(4):437-41
references: 12170362
references: Pediatr Cardiol. 2005 Sep-Oct;26(5):595-600
references: 15690237
references: Circulation. 2010 Nov 23;122(21):2123-30
references: 21060075
references: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references: 15033648
references: Br J Anaesth. 2003 Jun;90(6):728-32
references: 12765886
references: Shock. 2001;16 Suppl 1:24-32
references: 11770029