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Steroids Improve Hemodynamics in Infants With Adrenal Insufficiency After Cardiac Surgery
Takuma Maeda1, Muneyuki Takeuchi2, Kazuya Tachibana2
1Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Steroid replacement therapy improved hemodynamics in infants after congenital heart disease surgery, but only for those with adrenal insufficiency. This study highlights the importance of assessing adrenal function post-surgery.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care
- Pediatric Endocrinology
Background:
- Infants undergoing surgery for congenital heart disease (CHD) are at risk for adrenal insufficiency (AI).
- The impact of AI on hemodynamic stability post-cardiac surgery requires further investigation.
Purpose of the Study:
- To determine if steroid replacement therapy improves hemodynamics in infants after CHD surgery.
- To ascertain if this improvement is contingent upon the presence of AI.
Main Methods:
- Retrospective cohort study of 32 infants (<3 months) post-cardiac surgery.
- Patients were categorized into adrenal insufficiency (AI) and normal adrenal function (N) groups based on corticotropin stimulation tests.
- Hemodynamic parameters (mean blood pressure, urine output) were compared before and after hydrocortisone administration.
Main Results:
- Seven patients (22%) developed AI.
- In the AI group, steroid therapy significantly increased mean blood pressure (53±8 to 68±9 mmHg) and urine output (2.7±1.0 to 4.8±1.9 mL/kg/h).
- No significant hemodynamic improvements were observed in the normal adrenal function group.
Conclusions:
- Adrenal insufficiency develops in approximately one-fifth of infants following CHD surgery.
- Steroid replacement therapy is beneficial for improving hemodynamics exclusively in the subgroup of infants with AI post-cardiac surgery.
Objective:
To investigate whether steroid replacement therapy improved hemodynamics in infants after surgery for congenital heart disease only when they develop adrenal insufficiency. The authors retrospectively investigated adrenal function and evaluated hemodynamic responses to steroid replacement therapy in infants after surgery for congenital heart disease.
Design:
Retrospective, cohort study.
Setting:
Intensive care unit in the National Cerebral and Cardiovascular Center Hospital in Japan.
Patients:
Thirty-two neonates and infants<3 months old who underwent cardiovascular surgery.
Interventions:
The patients were divided into 2 groups based on corticotropin stimulation test results: group AI with adrenal insufficiency (baseline cortisol<15 µg/dL or incremental increase after testing of<9 µg/dL, with baseline cortisol of 15-34 µg/dL); and group N with normal adrenal function. The corticotropin stimulation test was performed by injecting 3.5 µg/kg of tetracosactide acetate. Hydrocortisone (1 mg/kg) was administered every 6 hours, and hemodynamics were compared before and after steroid administration between the groups.
Measurements And Main Results:
Seven patients were classified into group AI, and demonstrated a mean blood pressure increase from 53±8 mmHg before treatment to 68±9 mmHg 18 hours after steroid administration (p<0.01). Urine output also increased, from 2.7±1.0 mL/kg/h to 4.8±1.9 mL/kg/h (p<0.05). In group N, neither mean blood pressure nor urine output increased after steroid administration.
Conclusions:
After surgery for congenital heart disease, one-fifth of infants developed adrenal insufficiency. Steroid replacement therapy improved hemodynamics only in the subgroup with adrenal insufficiency.
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