title: Adrenal insufficiency in children undergoing heart surgery does not correlate with more complex postoperative course.
abstract: Although some evidence suggests benefit of steroid supplementation after pediatric cardiac surgery, data correlating adrenal function with the postoperative course is scarce. This study sought to determine if adrenal insufficiency (AI) after cardiac surgery is associated with a more complicated postoperative course in children. A prospective study was performed during a 6-month period at a pediatric medical center. Included were 119 children, 3 months and older, who underwent heart surgery with cardiopulmonary bypass. Cortisol levels were measured before and 18 h after surgery. Patients were divided into two groups by procedure complexity (low or high), and clinical and laboratory parameters were compared between patients with and without AI within each complexity group. In the low-complexity group, 45 of the 65 patients had AI. The normal adrenal function (NAF) subgroup had greater inotropic support at 12, 24, and 36 h after surgery and a higher lactate level at 12 and 24 h after surgery. There were no significant differences between subgroups in duration of ventilation, sedation, intensive care unit (ICU) stay, or urine output. In the high-complexity group, 27 patients had AI, and 27 did not. There were no significant differences between subgroups in inotropic support or urine output during the first 36 h or in mechanical ventilation, sedation, or ICU stay duration. Children with AI after heart surgery do not have a more complex postoperative course than children with NAF. The adrenal response of individual patients seems to be appropriate for their cardiovascular status.
authors.affiliation: Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petach Tikva, Israel, schillero@gmail.com.
authors.forename: Ofer
authors.initials: O
authors.lastname: Schiller
authors.forename: Ovdi
authors.initials: O
authors.lastname: Dagan
authors.forename: Einat
authors.initials: E
authors.lastname: Birk
authors.forename: Sarit
authors.initials: S
authors.lastname: Bitan
authors.forename: Gabriel
authors.initials: G
authors.lastname: Amir
authors.forename: George
authors.initials: G
authors.lastname: Frenkel
authors.forename: Elhanan
authors.initials: E
authors.lastname: Nahum
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000378:metabolism*; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007557:Israel / Q000453:epidemiology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone; D008775:Methylprednisolone