Skip to main content

No Benefit of Corticosteroids in Neonatal Heart Surgery

NEW YORK (Reuters Health) Jan 25 - Methylprednisolone does not improve outcomes in newborns undergoing cardiac surgery, and it may increase the risk of infection in some of those infants, an observational analysis suggests.
"These data reinforce the need for a large randomized trial in this population," the authors conclude in their report, published online January 23 in Pediatrics.
Dr. Sara K. Pasquali, with Duke University Medical Center in Durham, North Carolina, and colleagues explain that corticosteroids are used in pediatric heart surgery to reduce the inflammatory response triggered by cardiopulmonary bypass. But while inflammatory markers are reduced, the clinical benefits are being increasingly questioned.
Using a congenital heart surgery database and another that provided data on medication usage, the researchers identified 3,180 newborns who had heart surgery over a five-year period. Twelve percent received methylprednisolone on the day before surgery, 28% received it on the day of surgery, 22% received it on both days, and 38% received no perioperative steroids at all.
Neither of the two primary outcomes -- in-hospital mortality and postoperative length of stay (LOS) - differed significantly between babies who did and did not receive steroids, according to the report.
Specifically, unadjusted in-hospital mortality was 10.5% with no steroids, compared to 13.7% with methylprednisolone on the day of surgery, 11.1% with methylprednisolone on the day before surgery, and 10.9% with treatment on both days (p=0.13)
Adjusted mortality odds ratios in the three groups given methylprednisolone were 1.28, 0.95, and 1.00, respectively.
LOS was 14 days in all groups except the one given methylprednisolone on the day of surgery, for which the LOS was 15 days, the report indicates.
Overall, the risk of postoperative infection was similar in all groups. However, when patients were classified as high or low surgical risk, there was a significantly increased likelihood of infection across all methylprednisolone regimens in the low-surgical-risk group, Dr. Pasquali and colleagues report.
"This multicenter observational analysis of methylprednisolone in neonates undergoing heart surgery, along with other recent studies, calls into question the benefits of corticosteroids in children undergoing heart surgery," they conclude, "and furthermore supports the need for an adequately powered clinical trial in this population."

Comments

Post a Comment

Popular posts from this blog

Contact Precautions May Have Unintended Consequences

Contact precautions, including gloves, gowns, and isolated rooms, have helped stem the transmission of hospital pathogens but have also had some negative consequences, according to findings from a new study. Healthcare worker (HCWs) visited patients on contact precautions less frequently than other patients and spent less time with those patients when they did visit, report Daniel J. Morgan, MD, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System, Baltimore, and colleagues. Moreover, patients on contact precautions also received fewer outside visitors. "Less contact with HCWs suggests that other unintended consequences of contact precautions still exist," Dr. Morgan and coauthors write. "The resulting decrease in HCW contact may lead to increased adverse events and a lower quality of patient care due to less consistent patient monitoring and poorer adherence to standard adverse event prevention methods (such...
Post a Comment
Read more

Obama Renominates Tavenner to Be CMS Chief

President Barack Obama yesterday renominated Marilyn Tavenner, the acting administrator of the Centers for Medicare & Medicaid Services (CMS), to serve in that post without the caveat of "acting" attached to it. If the Senate approves her nomination, Tavenner will be the first confirmed, full-fledged CMS administrator since Mark McClellan, MD, PhD, stepped down from that position in October 2006, during the George W. Bush administration. Dr. McClellan's successors either were acting administrators or, in the case of Donald Berwick, MD, who was Tavenner's immediate predecessor, a recess appointment. As illustrated by Dr. Berwick's  CMS history , Senate confirmation can be tough to get when one party has enough votes to filibuster and otherwise stymie a nomination by an opposing party's president. That was the case when Obama nominated Dr. Berwick, whom Senate Republicans portrayed as an advocate of healthcare rationing, a characterization denied by t...
Post a Comment
Read more

Secondary Prevention: Clinical Approaches to Managing the Higher-Risk Patient with Heart Disease

INCIDENCE/PREVALENCE/BURDENS ASSOCIATED WITH CARDIOVASCULAR DISEASE (CVD) The prevention of an initial and recurrent cardiovascular event and other complications, such as diabetes and kidney failure [also known as end-stage renal disease (ESRD) or chronic kidney disease (CKD) stage 5] is an important goal in patients with a history of CVD. Each year, approximately 185,000 Americans suffer a recurrent stroke, approximately 470,000 will have a recurrent coronary attack, and an estimated 325,000 will suffer a recurrent myocardial infarction. [1]  Secondary prevention strategies offer the opportunity to prevent further complications and improve outcomes by early detection and management of common comorbidities. The burden on public health and the costs associated with chronic illnesses such as CVD, CKD, and diabetes remain high. An estimated 82.6 million American adults (1 in 3) have 1 or more types of CVD. [1]  Heart failure is the fastest-growing clinical cardiac disease ...
Post a Comment
Read more