Abstract
Key Questions
1. Do corticosteroids improve survival rates in infants undergoing cardiac surgery?
The analysis found no significant difference in postoperative mortality between groups receiving corticosteroids and placebo.
2. What are the side effects of corticosteroids in this context?
Corticosteroids were associated with significantly increased insulin treatment in infants, indicating a higher risk of hyperglycemia.
3. Do corticosteroids reduce the duration of mechanical ventilation?
Yes, the study observed a significant reduction in the duration of mechanical ventilation in neonates treated with corticosteroids.
4. Are corticosteroids routinely recommended for infants undergoing CPB?
Current evidence does not support the routine use of prophylactic corticosteroids in infants undergoing cardiac surgery with CPB.
Abstract
Background
Prophylactic corticosteroids have been widely used to mitigate the inflammatory response induced
by cardiopulmonary bypass (CPB). However, the impact of this treatment on clinically important outcomes in infants
remains uncertain.
Methods
We systematically searched databases (Medline, Embase, and Cochrane Central Register of Controlled Trials), Clinical
Trials Registry, and Google Scholar from inception to March 1, 2024. Randomized controlled trials (RCTs) in which infants
undergoing on-pump cardiac surgery received prophylactic corticosteroids or placebo were selected. The risk of bias
was assessed using the Cochrane Collaboration risk-of-bias tool. Considering clinical heterogeneity between studies,
the random-effects model was used for analysis. Subgroup analyses on the neonatal studies and sensitivity analyses by
the leave-one-out method were also conducted.
Results
Eight RCTs comprising 1,920 patients were included. Our analysis suggested no significant difference in postoperative
mortality (2.1% vs. 3.3%, risk ratio (RR) = 0.71, 95% confidence interval (CI) [0.41, 1.21]). Significantly increased insulin
treatment in infants (19.0% vs. 6.5%, RR = 2.78, 95% CI [2.05, 3.77]) and significantly reduced duration of mechanical
ventilation in neonates (mean difference = -22.28 h, 95% CI [-42.58, -1.97]) were observed in the corticosteroids group.
There were no differences between groups for postoperative acute kidney injury, cardiac arrest, extracorporeal membrane
oxygenation support, low cardiac output syndrome, neurologic events, infection, or length of postoperative intensive care
unit stay.
Conclusions
Current evidence does not support the routine prophylactic use of corticosteroids in infants undergoing cardiac surgery
with CPB. Further large-scale research is needed to investigate the optimal agent, dosing regimen, and specific impact
on various types of cardiac surgery.
Trial Registration
This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews
(CRD42023400176).
Keywords
Corticosteroids, Cardiac surgery, Infants, Perioperative medicine
