Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations : A Randomized Controlled Trial

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Suominen , P K , Keski-Nisula , J , Ojala , T , Rautiainen , P , Jahnukainen , T , Hastbacka , J , Neuvonen , P J , Pitkanen , O , Niemela , J , Kaskinen , A , Salminen , J & Lapatto , R 2017 , ' Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations : A Randomized Controlled Trial ' , Annals of Thoracic Surgery , vol. 104 , no. 4 , pp. 1378-1385 . https://doi.org/10.1016/j.athoracsur.2017.01.111

Title: Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations : A Randomized Controlled Trial
Author: Suominen, Pertti K.; Keski-Nisula, Juho; Ojala, Tiina; Rautiainen, Paula; Jahnukainen, Timo; Hastbacka, Johanna; Neuvonen, Pertti J.; Pitkanen, Olli; Niemela, Jussi; Kaskinen, Anu; Salminen, Jukka; Lapatto, Risto
Contributor: University of Helsinki, Clinicum
University of Helsinki, Children's Hospital
University of Helsinki, Children's Hospital
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Children's Hospital
University of Helsinki, Children's Hospital
University of Helsinki, Medicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Children's Hospital
University of Helsinki, Clinicum
Date: 2017-10
Language: eng
Number of pages: 8
Belongs to series: Annals of Thoracic Surgery
ISSN: 0003-4975
URI: http://hdl.handle.net/10138/298127
Abstract: Background. Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome. Methods. Forty neonates undergoing elective open heart operations were randomized into two groups. The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6 hours after the operation, a hydrocortisone infusion (0.2 mg/kg/h) was started with tapering doses for 5 days. Placebo was administered in a similar fashion. An adrenocorticotropic hormone stimulation test was performed after the therapy. The primary endpoint of the study was plasma concentration of interleukin (IL-6). Secondary clinical outcomes included plasma cortisol, IL-10, C-reactive protein, echocardiographic systemic ventricle contractility evaluated by the Velocity Vector Imaging program, the inotropic score, and time of delayed sternal closure. Results. The IL-6 values of the SDC group were significantly lower postoperatively than in the placebo group. Significantly lower inotropic scores (p <0.05), earlier sternal closure (p = 0.03), and less deterioration in the systemic ventricle mean delta strain values between the preoperative and the first postoperative assessment (p = 0.01) were detected for the SDC group. The SDC therapy did not suppress the hypothalamic-pituitary-adrenal axis more than placebo. The mean plasma cortisol level did not decline in the placebo group after the operation. Conclusions. The SDC regimen for 5 days post-operatively in neonates was safe and did not cause suppression of the hypothalamic-pituitary-adrenal axis. Furthermore, the open heart operation per se did not lead to adrenal insufficiency in neonates. (C) 2017 by The Society of Thoracic Surgeons
Subject: CONGENITAL HEART-SURGERY
SPECKLE-BASED STRAIN
CARDIOPULMONARY BYPASS
ADRENAL INSUFFICIENCY
MAGNETIC-RESONANCE
CHILDREN
METHYLPREDNISOLONE
SUPPLEMENTATION
LEVOSIMENDAN
VALIDATION
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
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