Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery

• Type of Material: Article
• Authors: Sinai C Zyblewski, Medical University of South Carolina; Reneé H Martin, Medical University of South Carolina; Viirginia B Shipes, Medical University of South Carolina; Kasey Hamlin-Smith, Medical University of South Carolina; Andrew M Atz, Medical University of South Carolina; Scott M Bradley, Medical University of South Carolina; Minoo N Kavarana, Medical University of South Carolina; William Mahle, Emory University; Allen D Everett, The Johns Hopkins University; Eric M Graham, University of South Carolina, Charleston
• Language: English
• Date: 2022-05-20
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by The Society of Thoracic Surgeons
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.athoracsur.2021.04.006
• Title of Journal or Parent Work: ANNALS OF THORACIC SURGERY
• Volume: 113
• Issue: 6
• Start Page: 2079
• End Page: 2084
• Keywords: Science & Technology; Respiratory System; FIBRILLARY ACIDIC PROTEIN; BRAIN-INJURY; NORWOOD PROCEDURE; Cardiovascular System & Cardiology; GREAT-ARTERIES; Surgery; Life Sciences & Biomedicine; CARDIOPULMONARY BYPASS; BIOMARKER; TRANSPOSITION; CHILDREN; Cardiac & Cardiovascular Systems; HYPOTHERMIC CIRCULATORY ARREST; BEHAVIOR

Abstract

Background: Neurodevelopmental impairment is an important consequence for survivors of surgery for critical congenital heart disease. This study sought to determine whether intraoperative methylprednisolone during neonatal cardiac surgery is associated with neurodevelopmental outcomes at 12 months of age and to identify early prognostic variables associated with neurodevelopmental outcomes. Methods: We performed a planned secondary analysis of a 2-center, double-blind, randomized, placebo-controlled trial of intraoperative methylprednisolone in neonates undergoing cardiac surgery. A brain injury biomarker was measured during surgery. Bayley Scales of Infant and Toddler Development-III (BSID-III) were performed at 12 months of age. Two-sample t tests and generalized linear models were used. Results: There were 129 participants (n = 61 methylprednisolone; n = 68 placebo). There were no significant differences in BSID-III scores and brain injury biomarker levels between treatment groups. Participants who underwent a palliative (versus corrective) procedure had lower mean BSID-III cognitive (101 ± 15 versus 106 ± 14; P = .03) and motor scores (85 ± 18 versus 94 ± 16; P < .01). Longer ventilation time was associated with lower motor scores. Longer cardiac intensive care unit stay was associated with lower cognitive, language, and motor scores. Cardiopulmonary bypass time, aortic cross-clamp time, and deep hypothermic circulatory arrest were not associated with BSID-III scores. Conclusions: Neurodevelopmental outcomes were not associated with intraoperative methylprednisolone or intraoperative variables. Participants who underwent a neonatal palliative (versus corrective) procedure had longer cardiac intensive care unit stays and worse neurodevelopmental outcomes at 1 year. This work suggests that interventions focused solely on the operative period may not be associated with a long-term neurodevelopmental benefit.