title: Steroids Improve Hemodynamics in Infants With Adrenal Insufficiency After Cardiac Surgery.
abstract: OBJECTIVE
  To investigate whether steroid replacement therapy improved hemodynamics in infants after surgery for congenital heart disease only when they develop adrenal insufficiency. The authors retrospectively investigated adrenal function and evaluated hemodynamic responses to steroid replacement therapy in infants after surgery for congenital heart disease.
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  Intensive care unit in the National Cerebral and Cardiovascular Center Hospital in Japan.
  
  
  METHODS
  Thirty-two neonates and infants<3 months old who underwent cardiovascular surgery.
  
  
  METHODS
  The patients were divided into 2 groups based on corticotropin stimulation test results: group AI with adrenal insufficiency (baseline cortisol<15 µg/dL or incremental increase after testing of<9 µg/dL, with baseline cortisol of 15-34 µg/dL); and group N with normal adrenal function. The corticotropin stimulation test was performed by injecting 3.5 µg/kg of tetracosactide acetate. Hydrocortisone (1 mg/kg) was administered every 6 hours, and hemodynamics were compared before and after steroid administration between the groups.
  
  
  RESULTS
  Seven patients were classified into group AI, and demonstrated a mean blood pressure increase from 53±8 mmHg before treatment to 68±9 mmHg 18 hours after steroid administration (p<0.01). Urine output also increased, from 2.7±1.0 mL/kg/h to 4.8±1.9 mL/kg/h (p<0.05). In group N, neither mean blood pressure nor urine output increased after steroid administration.
  
  
  CONCLUSIONS
  After surgery for congenital heart disease, one-fifth of infants developed adrenal insufficiency. Steroid replacement therapy improved hemodynamics only in the subgroup with adrenal insufficiency.
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Intensive Care Unit, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Electronic address: mtake@mch.pref.osaka.jp.
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Intensive Care Unit, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Tachibana
authors.affiliation: Department of Anesthesiology, Suita Tokushukai Hospital, Osaka, Japan.
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.affiliation: Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imanaka
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: adrenal insufficiency; congenital heart defects; corticosteroids; hemodynamics; infant; postoperative care