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Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised

Muhammad M Amanullah1, Mohammad Hamid2, Hashim M Hanif1

  • 11Department of Surgery,AKUH,Karachi,Pakistan.

Cardiology in the Young
|April 29, 2015
PubMed

Insights

Intravenous dexamethasone in children undergoing open-heart surgery reduced Interleukin-6 and increased Interleukin-10, but did not improve short-term clinical outcomes. This study investigated steroid effects on pediatric cardiac surgery inflammatory markers.

Area of Science:

  • Pediatric Cardiac Surgery
  • Immunology
  • Pharmacology

Background:

  • Cardiopulmonary bypass triggers a systemic inflammatory response in pediatric patients undergoing open-heart surgery.
  • The use of steroids to mitigate this response is debated, with limited clinical evidence.
  • This study aimed to evaluate the impact of intravenous steroids on inflammatory markers and clinical outcomes in children.

Purpose of the Study:

  • To assess the effects of intravenous dexamethasone on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery.
  • To investigate the immunomodulatory effects of steroids in pediatric cardiac surgery.
  • To determine if steroid administration improves early clinical outcomes after congenital heart defect repair.

Main Methods:

  • A randomized controlled trial was conducted with 152 pediatric patients (1 month to 18 years) undergoing open-heart surgery.
  • Patients received either intravenous dexamethasone (1 mg/kg) or a placebo in three scheduled doses.
  • Serum levels of Interleukin-6, 8, 10, 18, and tumor necrosis factor-alpha were measured at four time points, along with clinical parameters.

Main Results:

  • Dexamethasone significantly reduced Interleukin-6 levels at 6 and 24 hours post-operatively (p<0.001).
  • Interleukin-10 levels were significantly higher at 6 hours post-operatively in the dexamethasone group (p<0.001).
  • No significant differences were observed in Interleukin-8, 18, tumor necrosis factor-alpha levels, or clinical parameters between the groups.

Conclusions:

  • Dexamethasone effectively suppressed Interleukin-6 and activated Interleukin-10, suggesting reduced immunopathology.
  • Despite immunomodulatory effects, dexamethasone did not translate into significant short-term clinical benefits in pediatric cardiac surgery patients.
  • Further research may be needed to explore long-term effects or alternative steroid regimens.
Abstract

Keywords:
Cardiopulmonary bypasscongenital heart diseaseinflammatory markerssteroids

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