Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery

• 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
• Journal Title: ANNALS OF THORACIC SURGERY
• Volume: Volume 113, Number 6
• Publisher: ELSEVIER SCIENCE INC | 2022-05-20, Pages 2079-2084
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.athoracsur.2021.04.006
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Respiratory System; Surgery; Cardiovascular System & Cardiology; FIBRILLARY ACIDIC PROTEIN; HYPOTHERMIC CIRCULATORY ARREST; CARDIOPULMONARY BYPASS; NORWOOD PROCEDURE; GREAT-ARTERIES; BRAIN-INJURY; CHILDREN; TRANSPOSITION; BIOMARKER; 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.