(28 - Saturday) Hemodynamic Effects of Prophylactic Post-operative Hydrocortisone Following Cardiopulmonary Bypass in Neonates Undergoing Cardiac Surgery

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Abstract: Introduction/

Objective: The use of prophylactic perioperative steroids in pediatric cardiac surgery has become a common practice, yet an explicit understanding of their utility remains a topic of much debate. Multiple studies have made a concerted effort to define the role of steroids in pediatric congenital heart surgery; however, steroid utilization remains haphazard.

Methods: This was a single-center retrospective cohort analysis. Data was gathered on all term neonates (>36 weeks gestation) who underwent cardiac surgery with the use of cardiopulmonary bypass within the first 28 days of life between September 1, 2015 and September 1, 2019. During this time, our institution implemented a standardized protocol for steroid utilization in congenital heart surgery. The protocol was as follows: patients received a bolus of intravenous hydrocortisone (4 mg/kg) upon admission to the cardiac intensive care unit, then 1 mg/kg every 6 hours x 48 hours, 1 mg/kg every 8 hours x 24 hours, 1 mg/kg every 12 hours x 24 hours, then stopped. Subjects who were unable to separate from bypass, required long-term post-operative dialysis, or long-term mechanical ventilation were excluded. Primary outcome measures included daily net fluid balance, urine output, total amount of inotropic support, and vasoactive inotropic score.

Results: Seventy-five patients met eligibility criteria (non-hydrocortisone group: n= 52; hydrocortisone group: n = 23). For post-operative days 0-4, we did not observe a significant difference in net fluid balance or vasoactive inotropic score between study groups. Similarly, we saw no major difference in secondary clinical outcomes including post-operative duration of mechanical ventilation, intensive care unit length of stay, hospital length of stay, and time from surgery to initiation of enteral feeds.

Conclusions: In contrast to prior analyses, our study was unable to demonstrate a significant difference in net fluid balance or vasoactive inotropic score with the administration of a tapered post-operative hydrocortisone bolus regimen. Similarly, we saw no effect on secondary clinical outcomes with steroid treatment. Our study highlights that further long-term randomized control studies are necessary to validate the potential clinical benefit of utilizing steroids in pediatric cardiac surgery, especially in the more fragile neonatal population.