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Prophylactic steroids for paediatric open-heart surgery: a systematic review
Suzi Robertson-Malt1, Mahmoud El Barbary
11. JBI Collaboration, National & Gulf Centre for Evidence Based Medicine 2. National and Gulf Centre for Evidence Based Medicine, Riyadh, Saudi Arabia.
Insights
Prophylactic corticosteroids in pediatric open-heart surgery show weak evidence for reducing ICU stay and ventilation duration. Further research is needed to clarify benefits and harms of this intervention in children.
Area of Science:
- Pediatric Cardiac Surgery
- Immunology
- Pharmacology
Background:
- Cardiopulmonary bypass in children can trigger inflammatory responses, leading to post-operative complications like hemodynamic instability, infections, and arrhythmias.
- Corticosteroids are sometimes used to mitigate this inflammation, but their efficacy and safety in pediatric patients are not well-established.
Purpose of the Study:
- To systematically review the benefits and harms of prophylactic corticosteroid administration versus placebo in pediatric patients undergoing open-heart surgery.
Main Methods:
- Searched multiple databases (Cochrane, MEDLINE, EMBASE) and grey literature without language restrictions.
- Included randomized and quasi-randomized controlled trials of corticosteroid use in pediatric open-heart surgery with reported clinical outcomes.
- Data were abstracted by two independent reviewers and meta-analyses were performed using a random-effects model.
Main Results:
- All-cause mortality data were incomplete and could not be assessed.
- Weak evidence suggested prophylactic corticosteroids may reduce intensive care unit (ICU) stay, peak core temperature, and duration of ventilation.
Conclusions:
- The clinical benefits and harms of prophylactic corticosteroids in pediatric open-heart surgery remain unclear due to limited and incomplete data.
- Further high-quality randomized controlled trials are necessary to definitively evaluate the role of corticosteroids in this patient population.
Background:
The immune response to cardiopulmonary bypass in infants and children can lead to a series of post-operative morbidities and mortality, that is, hemodynamic instability, increased infection and tachyarrhythmias. Administration of prophylactic doses of corticosteroids is sometimes used to try and ameliorate this pro-inflammatory response. However, the clinical benefits and harms of this type of intervention in the paediatric patient remain unclear.
Objectives:
To systematically review the beneficial and harmful effects of the prophylactic administration of corticosteroids, compared with placebo, in paediatric open-heart surgery.
Search Strategy:
The trials registry of the Cochrane Heart Group, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to January 2007), EMBASE (1980 to January 2007) were searched. An additional hand-search of the EMRO database for Arabic literature was performed. Grey literature was searched, and experts in the field were contacted for any unpublished material. No language restrictions were applied.
Selection Criteria:
All randomised and quasi-randomised controlled trials of open-heart surgery in the paediatric population that received corticosteroids pre-, peri- or post-operatively, with reported clinical outcomes in terms of morbidity and mortality.
Data Collection And Analysis:
Eligible studies were abstracted and evaluated by two independent reviewers. All meta-analyses were completed using RevMan4.2.8. Weighted mean difference (WMD) was the primary summary statistic with data pooled using a random-effects model.
Main Results:
All cause mortality could not be assessed as the data reports were incomplete. There was weak evidence in favour of prophylactic corticosteroid administration for reducing intensive care unit stay, peak core temperature and duration of ventilation (WMD (95% confidence intervals) -0.50 h (-1.41 to 0.41); -0.20°C (-1.16 to 0.77) and -0.63 h (-4.02 to 2.75) respectively).
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