Landry Lily M, Gajula Viswanath, Knudson Jarrod D, Jenks Christopher L
Department of Pediatrics, Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Pediatrics, Division of Pediatric Critical Care, University of Mississippi Medical Center, Jackson, MS, USA.
Cardiol Young. 2023 Dec;33(12):2504-2510. doi: 10.1017/S1047951123000537. Epub 2023 Mar 23.
Multiple studies have endeavoured to define the role of steroids in paediatric congenital heart surgery; however, steroid utilisation remains haphazard. In September, 2017, our institution implemented a protocol requiring that all neonates undergoing cardiac surgery with the use of cardiopulmonary bypass receive a five-day post-operative hydrocortisone taper. This single-centre retrospective study was designed to test the hypothesis that routine post-operative hydrocortisone administration reduces the incidence of capillary leak syndrome, leads to favourable postoperative fluid balance, and less inotropic support in the early post-operative period. Data were gathered on all term neonates who underwent cardiac surgery with the use of bypass between September, 2015 and 2019. Subjects who were unable to separate from bypass, required long-term dialysis, or long-term mechanical ventilation were excluded. Seventy-five patients met eligibility criteria (non-hydrocortisone group = 52; hydrocortisone group = 23). For post-operative days 0-4, we did not observe a significant difference in net fluid balance or vasoactive inotropic score between study groups. Similarly, we saw no major difference in secondary clinical outcomes (post-operative duration of mechanical ventilation, ICU/hospital length of stay, and time from surgery to initiation of enteral feeds). In contrast to prior analyses, our study was unable to demonstrate a significant difference in net fluid balance or vasoactive inotropic score with the administration of a tapered post-operative hydrocortisone regimen. Similarly, we saw no effect on secondary clinical outcomes. Further long-term randomised control studies are necessary to validate the potential clinical benefit of utilising steroids in paediatric cardiac surgery, especially in the more fragile neonatal population.
多项研究致力于明确类固醇在小儿先天性心脏病手术中的作用；然而，类固醇的使用仍无章可循。2017年9月，我们机构实施了一项方案，要求所有接受体外循环心脏手术的新生儿术后接受为期五天的氢化可的松递减治疗。这项单中心回顾性研究旨在验证以下假设：术后常规给予氢化可的松可降低毛细血管渗漏综合征的发生率，实现良好的术后液体平衡，并减少术后早期的血管活性药物支持。收集了2015年9月至2019年期间所有接受体外循环心脏手术的足月儿的数据。无法脱离体外循环、需要长期透析或长期机械通气的受试者被排除。75名患者符合入选标准（非氢化可的松组 = 52；氢化可的松组 = 23）。在术后第0 - 4天，我们未观察到研究组之间在净液体平衡或血管活性药物评分方面存在显著差异。同样，我们在次要临床结局（机械通气术后持续时间、重症监护病房/住院时间以及从手术到开始肠内喂养的时间）方面也未发现重大差异。与之前的分析不同，我们的研究未能证明术后给予递减氢化可的松方案在净液体平衡或血管活性药物评分方面存在显著差异。同样，我们也未观察到对次要临床结局有任何影响。有必要进行进一步的长期随机对照研究，以验证在小儿心脏手术中使用类固醇的潜在临床益处，尤其是在更为脆弱的新生儿群体中。
