title: Methylprednisolone in neonatal cardiac surgery: reduced inflammation without improved clinical outcome.
abstract: BACKGROUND
  Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions.
  
  
  METHODS
  Forty neonates undergoing open-heart surgery were randomized in a double-blind fashion equally into 2 groups. After the induction of anesthesia, 1 group received 30 mg/kg intravenous methylprednisolone and the other a placebo. Concentrations in plasma of interleukin 6 (IL-6), IL-8, IL-10, free methylprednisolone and total methylprednisolone were obtained for the following: (1) at anesthesia induction before the study drug was administered; (2) 30 minutes on cardiopulmonary bypass; (3) 5 minutes after protamine administration; and (4) 6 hours after weaning from cardiopulmonary bypass. Troponin T was measured at time points T1, T3, T4, and also at 6:00 on the first postoperative morning. Physiological and clinical outcome parameters were also recorded.
  
  
  RESULTS
  Intravenous methylprednisolone resulted in high plasma drug concentrations that peaked at T2. Methylprednisolone significantly lowered concentrations of proinflammatory cytokines IL-6 and IL-8 and raised levels of anti-inflammatory IL-10. No significant differences in troponin T levels were detected. Blood glucose levels were significantly higher in the methylprednisolone group, and patients in this group received more often insulin therapy than controls. No significant differences were observed in other clinical or physiological outcome measurements.
  
  
  CONCLUSIONS
  Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass resulted in high effective plasma drug concentrations and a decreased inflammatory response. However, no cardioprotective effect or better clinical outcome was noticed.
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. juho.keski-nisula@hus.fi
authors.forename: Juho
authors.initials: J
authors.lastname: Keski-Nisula
authors.forename: Eero
authors.initials: E
authors.lastname: Pesonen
authors.forename: Klaus T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: Kaija
authors.initials: K
authors.lastname: Peltola
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Neuvonen
authors.forename: Netta
authors.initials: N
authors.lastname: Tuominen
authors.forename: Heikki
authors.initials: H
authors.lastname: Sairanen
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.forename: Pertti K
authors.initials: PK
authors.lastname: Suominen
mesh_terms: D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007378:Interleukins / Q000097:blood / Q000378:metabolism; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007378:Interleukins; D008775:Methylprednisolone