Steroid replacement therapy for severe heart failure after Norwood procedure

A 15-day-old neonate demonstrated severe heart failure and capillary leak syndrome after undergoing a Norwood procedure for hypoplastic left heart syndrome. Because she developed severe subcutaneous edema and baseline blood cortisol was low, we suspected relative adrenal insufficiency. After 18 days of dexamethasone administration, her hemodynamics and respiratory function improved, and she was successfully extubated and discharged from hospital. When hemodynamics are unstable in neonates after major cardiac surgery, relative adrenal insufficiency and steroid replacement should be considered.