title: Preoperative steroid treatment does not improve markers of inflammation after cardiac surgery in neonates: results from a randomized trial.
abstract: OBJECTIVE
  Neonatal cardiac surgery requiring cardiopulmonary bypass results in a heightened inflammatory response. Perioperative glucocorticoid administration is commonly used in an attempt to reduce the inflammatory cascade, although characterization of the cytokine response to steroids in neonatal cardiac surgery remains elusive because of highly variable approaches in administration. This randomized trial was designed to prospectively evaluate the effect of specific glucocorticoid dosing protocols on inflammatory markers in neonatal cardiac surgery requiring cardiopulmonary bypass.
  
  
  METHODS
  Neonates scheduled for cardiac surgery were randomly assigned to receive either 2-dose (8 hours preoperatively and operatively, n = 36) or single-dose (operatively, n = 32) methylprednisolone at 30 mg/kg per dose in a prospective double-blind trial. The primary outcome was the effect of these steroid regimens on markers of inflammation. Secondary analyses evaluated the association of specific cytokine profiles with postoperative clinical outcomes.
  
  
  RESULTS
  Patient demographics, perioperative variables, and preoperative indices of inflammation were similar between the single- and 2-dose groups. Preoperative cytokine response after the 2-dose methylprednisolone protocol was consistent with an anti-inflammatory effect, although this did not persist into the postoperative period. Premedication baseline levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor α were predictive of postoperative intensive care unit and hospital length of stay. Only interleukin-8 demonstrated a postoperative response associated with duration of intensive care unit and hospital stay.
  
  
  CONCLUSIONS
  The addition of a preoperative dose of methylprednisolone to a standard intraoperative methylprednisolone dose does not improve markers of inflammation after neonatal cardiac surgery. The routine administration of preoperative glucocorticoids in neonatal cardiac surgery should be reconsidered.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. Electronic address: grahamem@musc.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Graham
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: McHugh
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Butts
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Baker
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Stroud
authors.affiliation: Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reeves
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Francis X
authors.initials: FX
authors.lastname: McGowan
authors.affiliation: Departments of Surgery and Cell Biology and Anatomy, USC School of Medicine, Columbia, SC.
authors.forename: Francis G
authors.initials: FG
authors.lastname: Spinale
mesh_terms: D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D011300:Preoperative Care; D011446:Prospective Studies; D013022:South Carolina; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D005938:Glucocorticoids; D018836:Inflammation Mediators; D008775:Methylprednisolone