Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass

Graham, Eric M.; Martin, Renée; Buckley, Jason R.; Zyblewski, Sinai C.; Kavarana, Minoo N.; Bradley, Scott M.; Alsoufi, Bahaaldin; Mahle, William T.; Hassid, Marc; Atz, Andrew M.

doi:10.1016/j.jacc.2019.05.060

Cited by 41 publications

(47 citation statements)

References 28 publications

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“…The similar result was found in another retrospective research involving neonatal patients (32). A recent randomized controlled study of 176 patients also failed to show a significant difference between corticosteroids and placebo in mortality, DMV, and LOIS with the analysis of two institutions adopting somewhat different perioperative management strategies (25), while the benefit of intraoperative corticosteroids was significant in one institution.…”

Section: Discussionsupporting

confidence: 75%

“…Heterogeneity was low among studies with Chi 2 = 4.69, P = 0.55, and with I 2 = 0%. However, one study (25) almost had half of the included population. As a result, the sensitivity analysis was performed to detect the effect of each study in outcomes.…”

Section: Mortality Duration Of Mechanical Ventilation and Length Ofmentioning

confidence: 99%

“…However, some potential adverse effects may be associated with corticosteroids, for example, hyperglycemia, poor wound healing, infections, and poor neurodevelopmental outcomes (6)(7)(8). Several small, randomized, controlled studies in pediatric patients have investigated the effect of perioperative corticosteroids on the inflammatory biomarkers, clinical outcomes, and adverse events after congenital heart surgeries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Nevertheless, the results were conflicted, resulting in the controversy over perioperative corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Luo

et al. 2020

Front. Pediatr.

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Background: The benefit-risk profile of perioperative corticosteroids in pediatric patients undergoing cardiac surgery remains controversial. Objective: To investigate the influence of perioperative corticosteroids on the postoperative mortality and clinical outcomes in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: We conducted a systematic search using MEDLINE, EMBASE, and Cochrane Database through August 31, 2019. We included randomized controlled trials comparing perioperative corticosteroids with other clinical interventions, placebo, or no treatment in children between 0 and 18 years of age undergoing cardiac surgery. The primary outcome of interest was all-cause in-hospital mortality. The secondary outcomes were length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), postoperative insulin therapy, postoperative low cardiac output syndrome (LCOS), postoperative infection, maximal temperature (T max) in the first 24 h postoperatively, urine output (UO) in the first 24 h postoperatively, serum lactate at postoperative day (POD) 1, blood glucose at POD 1, vasoactive inotrope score (VIS) at POD 1, and postoperative acute kidney injury (AKI). Study quality was assessed using the Cochrane Risk of Bias Assessment Tool. Results: Our analysis included 17 studies and 848 pediatric patients. The data demonstrated that children receiving corticosteroids showed no significant difference on the all-cause in-hospital mortality with a fixed-effect model (RR = 0.59, 95% CI = 0.28-1.25, P = 0.55) compared with controls. For the secondary outcomes, corticosteroids had a statistically significant reduction on the VIS at POD1 (MD = −2.04, 95% CI = −3.96 −0.12, P = 0.04), while it might be significantly associated with an increased blood glucose at POD1 (MD = 1.38, 95% CI = 0.68-2.09, P = 0.0001) and a 2.69-fold higher risk of postoperative insulin therapy (RR = 2.69, 95% CI = 1.37-5.27, P = 0.004). No statistical significance was shown in other secondary outcomes. Conclusion: Perioperative corticosteroids might not significantly improve clinical outcomes identified as mortality, LOIS, DMV, AKI, and LCOS other than VIS at Li et al. Corticosteroids in Pediatric Cardiac Surgery POD1. However, it might increase the blood glucose and episodes of insulin therapy. Perioperative corticosteroids to attenuate the inflammatory response are not supported by available evidence from our study. Further results from ongoing randomized controlled trials with a larger sample size are required.

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Section: Discussionsupporting

confidence: 75%

Section: Mortality Duration Of Mechanical Ventilation and Length Ofmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Luo

et al. 2020

Front. Pediatr.

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“…13 Although cyclohexanone has been shown to leach from IV tubing, infusion sets, and importantly, CPB circuits, circulating cyclohexanone levels, its metabolism, and associated clinical outcomes are understudied. [18][19][20][21][22][23][24] Because of its length, multiple stopcocks, and tubing connects, the CPB circuit in particular could be a significant reservoir for residual cyclohexanone. In a 2009 study, 23 cyclohexanone was demonstrated to leach from CPB circuits with saline at levels of 210 to 698 μg/L.…”

Section: Discussionmentioning

confidence: 99%

Association of Neurodevelopmental Outcomes With Environmental Exposure to Cyclohexanone During Neonatal Congenital Cardiac Operations

et al. 2020

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IMPORTANCE Cyclohexanone is an industrial solvent used as a coupling agent in medical plastics. Perioperative exposure to cyclohexanone could play a role in lower scores on measures of neurodevelopmental outcomes after neonatal cardiac operations. OBJECTIVE To examine the presence and association of serum cyclohexanone level with neonatal cardiac operations and neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS This ad hoc secondary analysis used data from the Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass randomized clinical trial.

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“…Findings from the Corticosteroids Therapy in Neonates Undergoing Cardiopulmonary Bypass trial were reported recently by Graham et al 9 The study included 176 patients (1 month old) at 2 North American centers (Medical University of South Carolina and Children's Healthcare of Atlanta at Emory University) in a double-blind randomized controlled trial of methylprednisolone (30 mg/kg) versus placebo after the induction of anesthesia. The objective was to determine whether a single dose of intraoperative corticosteroid improves postoperative recovery in neonates undergoing congenital cardiac surgery by assessing a previously validated primary composite outcome of morbidity-mortality.…”

mentioning

confidence: 96%