Intraoperative Steroid Use and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network's Public Database.
OBJECTIVE
Data supporting the use of perioperative steroids during cardiac surgery are conflicting, and most pediatric studies have been limited by small sample sizes and/or diverse cardiac diagnoses. The objective of this study was to determine if intraoperative steroid administration improved outcomes following the Norwood procedure.


METHODS
A retrospective analysis was performed on the 549 neonates who underwent a Norwood procedure in the publicly available datasets from the Pediatric Heart Network's Single Ventricle Reconstruction trial. Groups were compared to determine if outcomes differed between intraoperative steroid recipients (n = 498, 91%) and nonrecipients (n = 51, 9%).


METHODS
Fifteen North American centers.


METHODS
Infants enrolled in the Single Ventricle Reconstruction trial.


METHODS
None.


RESULTS
Baseline characteristics and intraoperative variables were similar between groups with the exception of a shorter duration of cross clamp and cardiopulmonary bypass time in the group that received steroids. Subjects who did not receive intraoperative steroids had improved hospital survival (94% vs 83%, p = 0.03) but longer ICU stays (16 d; interquartile range, 12-33 vs 14 d; interquartile range, 9-28; p = 0.04) and hospital stays (29 d; interquartile range, 21-50 vs 23 d; interquartile range, 15-40; p = 0.01) than steroid recipients. In multivariate analysis, lengths of stay associations were no longer significant, but hospital survival trended toward favoring the nonsteroid group with an odds ratio of 3.52 (95% CI, 0.98-12.64; p = 0.054).


CONCLUSIONS
In the large multicentered Single Ventricle Reconstruction trial, there was widespread use of intraoperative steroids. Intraoperative steroid administration was not associated with an improvement in outcomes and may be associated with a reduction in hospital survival in neonates undergoing the Norwood procedure. This study highlights the need for a randomized control trial.
1Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC. 2Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Justin J
JJ
Elhoff
Shahryar M
SM
Chowdhury
Sinai C
SC
Zyblewski
Andrew M
AM
Atz
Scott M
SM
Bradley
Eric M
EM
Graham
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D016017:Odds Ratio; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000305:Adrenal Cortex Hormones