Corticosteroids before cardiac surgery do not reduce death risk for children
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Key takeaways:
- Prophylactic corticosteroids do not reduce in-hospital mortality in children who undergo cardiac surgery.
- Researchers observed a hospital length-of-stay benefit for children who received corticosteroids.
Perioperative corticosteroids did not improve in-hospital mortality for children who underwent cardiac surgery with cardiopulmonary bypass, though corticosteroids may reduce hospital length of stay, data show.
“Corticosteroids have been used prophylactically in pediatric heart surgery for over 60 years, but their use is still debated,” Yongchun Du, MD, a pediatric surgeon with Huai’an Maternal and Child Health Care Hospital, China, and Daliu Chen, MD, a gastrointestinal surgeon with Chunzhou County Hospital of Huai'an City, China, wrote in Clinical Cardiology. “Corticosteroids are used in cardiopulmonary bypass pediatric cardiac surgery for three reasons: to reduce the extracorporeal circuit‐induced systemic inflammatory response syndrome (SIRS), to offer perioperative supplementation for anticipated relative adrenal insufficiency; and for the presumed neuroprotective impact during profound hypothermic circulatory arrest surgeries.”
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In a meta-analysis, Du and Chen analyzed data from 10 randomized controlled trials with 7,798 pediatric patients who underwent cardiac surgery. Six articles assessed the effects of methylprednisolone and four assessed the efficacy of dexamethasone. Studies compared perioperative corticosteroids with other therapeutic therapies, placebo or no treatment.
The primary outcome was all‐cause hospital mortality; secondary outcome was hospitalization duration.
In a random-effects model, researchers did not observe differences in all-cause hospital mortality among children who received corticosteroids compared with children who received other therapies, placebo or no treatment. The pooled RR for methylprednisolone was 0.38 (95% CI, 0.16-0.91; I2 = 79%; P = .03), whereas the pooled RR for dexamethasone was 0.29 (95% CI = 0.09-0.97; I2 = 80%; P = .04).
For length of hospital stay, researchers observed significant differences between children who received corticosteroids vs. those who received placebo. The pooled standard mean difference (SMD) for methylprednisolone was –0.86 (95% CI, 1.57 to 0.15; I2 = 85%; P = .02) and the SMD for dexamethasone was 0.97 (95% CI, 1.9 to 0.04; I2 = 83%; P = .04.)
The researchers noted the trials used a wide range of corticosteroid doses, administration frequencies and types, suggesting that subgroup analysis could be necessary. Additionally, most studies had relatively small sample sizes.
“We showed that the administration of perioperative corticosteroids may not significantly improve the clinical outcomes of all‐cause mortality and length of hospital stay in children undergoing heart surgery,” Du and Chen wrote. “To draw definitive conclusions about the risk‐benefit profile of these perioperative corticosteroids, more data are urgently required from ongoing randomized controlled trials involving the administration of corticosteroids such as dexamethasone and methylprednisolone to reduce systemic inflammation after neonatal and pediatric cardiac surgery.”
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