Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Ann Thorac Surg. 2022 Jun;113(6):2079-2084. doi: 10.1016/j.athoracsur.2021.04.006. Epub 2021 Apr 20.
Neurodevelopmental impairment is an important consequence for survivors of surgery for critical congenital heart disease. This study sought to determine whether intraoperative methylprednisolone during neonatal cardiac surgery is associated with neurodevelopmental outcomes at 12 months of age and to identify early prognostic variables associated with neurodevelopmental outcomes.
We performed a planned secondary analysis of a 2-center, double-blind, randomized, placebo-controlled trial of intraoperative methylprednisolone in neonates undergoing cardiac surgery. A brain injury biomarker was measured during surgery. Bayley Scales of Infant and Toddler Development-III (BSID-III) were performed at 12 months of age. Two-sample t tests and generalized linear models were used.
There were 129 participants (n = 61 methylprednisolone; n = 68 placebo). There were no significant differences in BSID-III scores and brain injury biomarker levels between treatment groups. Participants who underwent a palliative (versus corrective) procedure had lower mean BSID-III cognitive (101 ± 15 versus 106 ± 14; P = .03) and motor scores (85 ± 18 versus 94 ± 16; P < .01). Longer ventilation time was associated with lower motor scores. Longer cardiac intensive care unit stay was associated with lower cognitive, language, and motor scores. Cardiopulmonary bypass time, aortic cross-clamp time, and deep hypothermic circulatory arrest were not associated with BSID-III scores.
Neurodevelopmental outcomes were not associated with intraoperative methylprednisolone or intraoperative variables. Participants who underwent a neonatal palliative (versus corrective) procedure had longer cardiac intensive care unit stays and worse neurodevelopmental outcomes at 1 year. This work suggests that interventions focused solely on the operative period may not be associated with a long-term neurodevelopmental benefit.
神经发育损伤是危重新生儿心脏手术后的一个重要后果。本研究旨在确定新生儿心脏手术期间使用甲基强的松龙是否与 12 个月时的神经发育结果相关，并确定与神经发育结果相关的早期预后变量。
我们对 2 个中心、双盲、随机、安慰剂对照的新生儿心脏手术中使用甲基强的松龙的研究进行了计划中的二次分析。术中测量了脑损伤生物标志物。12 个月时进行贝利婴幼儿发展量表第三版（BSID-III）评估。使用两样本 t 检验和广义线性模型。
共有 129 名参与者（n = 61 例甲基强的松龙；n = 68 例安慰剂）。治疗组之间的 BSID-III 评分和脑损伤生物标志物水平无显著差异。接受姑息（而非矫正）手术的参与者的平均 BSID-III 认知评分（101 ± 15 对 106 ± 14；P =.03）和运动评分（85 ± 18 对 94 ± 16；P <.01）较低。通气时间较长与运动评分较低相关。心脏重症监护病房停留时间较长与认知、语言和运动评分较低相关。体外循环时间、主动脉阻断时间和深低温循环停止时间与 BSID-III 评分无关。
神经发育结果与术中甲基强的松龙或术中变量无关。接受新生儿姑息（而非矫正）手术的参与者心脏重症监护病房停留时间较长，1 年后神经发育结果较差。这项工作表明，仅关注手术期间的干预措施可能不会带来长期的神经发育益处。
