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Administration of steroids in pediatric cardiac surgery: impact on clinical outcome and systemic inflammatory
1University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland. peter.gessler@kispi.unizh.ch
Insights
Pre-bypass steroid administration did not improve postoperative recovery in infants undergoing heart surgery. Prednisolone did not significantly impact inflammatory markers or clinical outcomes following cardiopulmonary bypass (CPB).
Area of Science:
- Pediatric Cardiovascular Surgery
- Critical Care Medicine
- Pharmacology
Background:
- Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response in infants undergoing heart surgery.
- Pre-bypass steroid administration is hypothesized to mitigate this inflammation and enhance postoperative recovery.
- The efficacy of perioperative steroids in pediatric cardiac surgery remains an area of investigation.
Purpose of the Study:
- To evaluate the impact of prednisolone administration during cardiopulmonary bypass on postoperative recovery in infants undergoing heart surgery.
- To assess whether pre-bypass steroid administration modulates the inflammatory response associated with CPB.
- To determine the influence of perioperative prednisolone on clinical and laboratory inflammatory markers.
Main Methods:
- Prospective study involving 50 infants undergoing heart surgery at two university hospitals.
- Patients were randomized to receive either prednisolone (30 mg/kg) in the CPB priming solution or no steroids.
- Clinical outcomes (inotropic support, oxygenation) and inflammatory markers (leukocytes, CRP, IL-8) were monitored postoperatively.
Main Results:
- Postoperative recovery, including inotropic support and oxygenation, was similar between steroid and non-steroid groups, adjusted for surgical complexity.
- A significant inflammatory response was observed post-CPB, particularly in patients with longer bypass times.
- Postoperative interleukin-8 levels correlated positively with CPB duration (r = 0.62, p < 0.001).
- Steroid administration showed no significant effect on laboratory inflammatory parameters or overall postoperative recovery.
Conclusions:
- Perioperative prednisolone administration into the CPB priming solution did not measurably improve postoperative recovery in infants undergoing heart surgery.
- Steroid administration did not suppress the systemic inflammatory response induced by cardiopulmonary bypass.
- The duration of CPB time is a significant factor associated with the postoperative inflammatory response, independent of steroid use.
Abstract:
Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Pre-bypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. We performed a prospective study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery. Patients received either prednisolone (30 mg/kg) added to the priming solution of the cardiopulmonary bypass circuit (steroid group) or no steroids (nonsteroid group). Clinical outcome parameters include therapy with inotropic drugs, oxygenation, blood lactate, glucose, and creatinine, and laboratory parameters of inflammation include leukocytes, C-reactive protein, and interleukin-8. Postoperative recovery (e.g., the number, dosage, and duration of inotropic drugs as well as oxygenation) was similar in patients treated with or without steroids when corrected for the type of cardiac surgery performed. After CPB, there was an inflammatory reaction, especially in patients with a long CPB time. Postoperative plasma levels of interleukin-8 were correlated with the duration of CPB time (r = 0.62, p < 0.001). Administration of steroids had no significant impact on the laboratory parameters of inflammation. Administration of prednisolone into the priming solution of the CPB circuit had no measurable influence on postoperative recovery and did not suppress the inflammatory response.
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