Methylprednisolone for Infant Heart Surgery: Subpopulation Analyses of a Randomized Controlled Trial

Area of Science:

• Cardiology
• Pediatric Surgery
• Pharmacology

Background:

• Infant heart surgery carries risks of systemic inflammation and complications.
• Prophylactic corticosteroids are used to mitigate these risks.
• The STRESS trial investigated methylprednisolone's efficacy and safety.

Purpose of the Study:

• To evaluate the benefits and harms of prophylactic intraoperative methylprednisolone in specific subpopulations of infants undergoing heart surgery.
• To identify subgroups that may benefit from or be harmed by this intervention.

Main Methods:

• Subpopulation analyses from the STRESS trial, a double-blind, randomized, placebo-controlled study.
• Infants (<1 year) undergoing heart surgery with cardiopulmonary bypass were stratified by STAT category, age, gestational age, and CSD.
• Methylprednisolone (30 mg/kg) or placebo was administered during cardiopulmonary bypass.

Main Results:

• Methylprednisolone reduced postoperative hydrocortisone use in neonates, STAT categories 1-5, term infants, and those without CSD.
• Lower thrombosis rates were observed in neonates and term infants receiving methylprednisolone.
• Adverse effects included increased thrombosis in premature infants, increased AKI in neonates and STAT 1-3 groups, and elevated peak blood glucose and insulin levels across subgroups.

Conclusions:

• Prophylactic methylprednisolone demonstrated both benefits (reduced hydrocortisone, no increased infection) and harms (increased glucose, potential AKI risk).
• Specific subpopulations may benefit from its use, but careful consideration of risks is necessary.
• Further research may refine patient selection for optimal outcomes.