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Cumulative corticosteroid exposure and infection risk after complex pediatric cardiac surgery

Christopher W Mastropietro1, Renee Barrett, Maria Caridad Davalos

  • 1Department of Pediatrics, Division of Critical Care, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan, USA. cmastrop@med.wayne.edu

The Annals of Thoracic Surgery
|April 23, 2013
PubMed

Insights

For children undergoing complex cardiac surgery, longer corticosteroid exposure is linked to increased infection risk. This finding highlights the need to carefully manage steroid use in pediatric cardiac patients to improve outcomes.

Area of Science:

  • Pediatric Cardiac Surgery
  • Critical Care Medicine
  • Pharmacology

Background:

  • Corticosteroids are used in pediatric cardiac surgery for inflammation, hemodynamic stability, and airway edema.
  • Emerging data suggest a link between preoperative corticosteroid use and infection risk.
  • The relationship between cumulative corticosteroid exposure and infection requires further investigation.

Purpose of the Study:

  • To investigate the association between cumulative corticosteroid exposure and the incidence of postoperative infection in children undergoing cardiac surgery.
  • To identify independent risk factors for infection in this patient population.

Main Methods:

  • Retrospective review of 76 children (≤5 years) undergoing cardiac surgery with specific inclusion criteria (Aristotle score ≥7, ICU stay ≥7 days).
  • Infections defined as clinically relevant positive cultures or prolonged antimicrobial therapy.
  • Multivariate logistic regression analysis to assess risk factors for infection.

Main Results:

  • 36% of patients developed infections.
  • Patients with infections had significantly longer corticosteroid exposure (median 7 vs. 4 days, p < 0.001).
  • Multivariate analysis identified days of corticosteroid exposure (p=0.015) and intubation (p=0.023) as independent risk factors for infection.

Conclusions:

  • Increased cumulative duration of corticosteroid exposure is independently associated with a higher risk of postoperative infection in children undergoing complex cardiac surgery.
  • Careful consideration of corticosteroid use duration is warranted in pediatric cardiac surgery patients.
Abstract

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