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11 Aug 2019
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Prophylactic methylprednisolone may benefit some neonates undergoing cardiac surgery

11 Aug 2019

Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.

However, patients undergoing palliative procedures seem to benefit from corticosteroid therapy. In addition, a significant interaction exists between treatment effect and centre, suggesting the possibility of centre or patient characteristics that make prophylactic methylprednisolone helpful.

This double-blind randomized controlled trial determined whether intraoperative methylprednisolone improved postoperative recovery in neonate undergoing cardiac surgery. The investigators enrolled 190 neonates undergoing cardiopulmonary bypass at two centres after the induction of anaesthesia, among whom 176 (n=81 methylprednisolone 30 mg/kg; n=95 placebo) were included in the analysis.

The primary endpoint was a previously validated morbidity-mortality composite of any of the following events after surgery before discharge: death, cardiac arrest, hepatic injury, renal injury, mechanical circulatory support or rising lactate level (>5 mmol/l).

These outcomes occurred in 27 (33 percent) neonates in the methylprednisolone group and 40 (42 percent) in the placebo group (odds ratio [OR], 0.63, 95 percent CI, 0.31–1.3; p=0.21). However, methylprednisolone led to decreases in vasoactive inotropic requirement and in the incidence of the composite endpoint in patients undergoing palliative operations (OR, 0.38, 0.15–0.99; p=0.048).

Furthermore, a significant interaction was observed between treatment effect and centre in this analysis. Corticosteroid therapy conferred a protective benefit at one centre (OR, 0.35, 0.15–0.84; p=0.02) but not at the other (OR, 5.13, 0.85–30.90; p=0.07).

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Most Read Articles
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
11 Aug 2019
Treatment with low-to-standard dose dual combination therapy of blood pressure (BP)-lowering drugs is more effective than standard-dose monotherapy and does not increase withdrawals due to adverse events, a recent study has shown.
20 Jun 2019
Untreated white coat hypertension (WCH), but not treated white coat effect (WCE), may increase the risk for cardiovascular events and all-cause mortality, suggest the results of a systematic review and meta-analysis. Out-of-office blood pressure (BP) monitoring is thus important in the diagnosis and management of hypertension.
06 Aug 2019
Risk factors for 1-year mortality in heart failure (HF) patients significantly differ between those with and without chronic kidney disease (CKD), especially with regard to the use of beta-blockers or diuretics at discharge, according to a study. This suggests that these patients may benefit from individualized therapies.