Cardiothoracic & vascular anesthesia
Methylprednisolone for Infant Heart Surgery: Subpopulation Analyses of a Randomized Controlled Trial
Authors' conclusion
Both beneficial and adverse associations were observed with prophylactic methylprednisolone.
Study context
- Population
- Infants (< 1 yr old) undergoing heart surgery with CPB, stratified by STAT mortality category, age, gestational age and chromosomal or syndromic diagnosis (CSD)
- Participants
- 1,200 infants
- Comparison
- Methylprednisolone vs placebo in CPB pump-priming fluid
- Primary endpoint
- Postoperative outcomes: steroid use, acute kidney injury (AKI), thrombosis, infections, prolonged mechanical ventilation, peak blood glucose levels, and insulin exposure
Methodological detailssubpopulation analyses, double-blind, placebo-controlled, multicentre (24 congenital heart centers)
- Subpopulation analyses
- Double-blind
- Placebo-controlled
- Multicentre (24 congenital heart centers)
Primary result
As reported in the abstract
Postoperative hydrocortisone use (subgroups)
Methylprednisolone vs PlaceboOdds ratio (CI)
Neonates
0.39(0.25–0.60)
STAT category 1-3
0.64(0.46–0.89)
STAT category 4-5
0.57(0.34–0.97)
Term infants
0.63(0.47–0.83)
Without CSD
0.63(0.46–0.86)
Further findings
| Outcome | OR (CI) | |
|---|---|---|
| Thrombosis (subgroups)Methylprednisolone vs Placebo · neonates | 0.37 (0.16–0.87) | |
| Thrombosis (subgroups)Methylprednisolone vs Placebo · term infants | 0.38 (0.19–0.75) | |
| 0.10.31310Odds ratio (log scale) |
Overall infection and prolonged mechanical ventilation
- No increase in overall infection or reduction in prolonged mechanical ventilation with methylprednisolone
Safety
| Outcome | OR (CI) | |
|---|---|---|
| AKI (subgroups)Methylprednisolone vs Placebo · neonates | 1.55 (1.02–2.37) | |
| AKI (subgroups)Methylprednisolone vs Placebo · STAT category 1-3 | 1.34 (1.02–1.75) | |
| 0.512Odds ratio (log scale) |
Thrombosis, premature infants (subgroup)
- Increased thrombosis among premature infants
- P = 0.005
Peak blood glucose levels and insulin exposure
- Increased in all subgroups
- P < 0.001
Original publication
Methylprednisolone for Infant Heart Surgery: Subpopulation Analyses of a Randomized Controlled Trial. Crit Care Med. Published 21 May 2025. doi:10.
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