Corticosteroids can improve mortality risk in Pediatric Cardiac Surgery

A new study published in the Journal of Clinical Cardiology suggest that perioperative corticosteroids may not significantly improve mortality rates but can lead to a reduced hospitalization duration.

The use of corticosteroids in children undergoing cardiac surgery remains a subject of debate, with conflicting opinions on its benefits and drawbacks. To shed light on the effects of perioperative corticosteroid administration on postoperative mortality and clinical outcomes in pediatric cardiac surgery involving cardiopulmonary bypass (CPB), a meta-analysis was conducted.

A comprehensive search of the MEDLINE, EMBASE, and Cochrane Database was performed, covering studies published up until January 2023. The meta-analysis included randomized controlled trials that compared perioperative corticosteroids with other therapeutic approaches, placebo, or no treatment in children aged 0 to 18 undergoing cardiac surgery. The primary endpoint of the study was all-cause hospital mortality, while the duration of hospitalization served as a secondary outcome. The quality of the research was assessed using the Cochrane Risk of Bias Assessment Tool.

The key findings of the study were:

The analysis incorporated ten trials comprising 7,798 pediatric participants. Children who received corticosteroids showed no significant difference in all-cause in-hospital mortality compared to other treatments.

The random-effect model yielded a relative risk (RR) of 0.38 (95% confidence interval [CI]: 0.16–0.91, I2 = 79%, p = 0.03) for methylprednisolone and RR of 0.29 (95% CI: 0.09–0.97, I2 = 80%, p = 0.04) for dexamethasone.

Regarding the secondary outcome, a significant difference was observed between the corticosteroid and placebo groups, with a pooled standard mean difference (SMD) of -0.86 (95% CI: -1.57 to -0.15, I2 = 85%, p = 0.02) for methylprednisolone and SMD of -0.97 (95% CI: -1.90 to -0.04, I2 = 83%, p = 0.04) for dexamethasone, indicating a reduction in hospital stay with corticosteroids compared to placebo.

In summary, the role of perioperative corticosteroids in preventing all-cause mortality events in pediatric cardiac surgery patients remains uncertain. This systematic review and meta-analysis highlight that the administration of corticosteroids during the perioperative period may not significantly improve clinical outcomes related to mortality and length of hospital stay in children undergoing heart surgery. Further research with larger sample sizes is needed to provide more conclusive evidence on the topic.

Source:

Chen, D., & Du, Y. (2023). Analysis of perioperative corticosteroid therapy in children undergoing cardiac surgery: A systematic review and meta‐analysis. In Clinical Cardiology. Wiley. https://doi.org/10.1002/clc.24018