Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery

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. (C) 2022 by The Society of Thoracic Surgeons

Automated summary

This study aimed to investigate the impact of intraoperative methylprednisolone during neonatal cardiac surgery on neurodevelopmental outcomes at 12 months of age and to identify early prognostic variables. The results showed that intraoperative methylprednisolone and other variables during surgery were not associated with neurodevelopmental outcomes. Participants who underwent a palliative procedure had worse neurodevelopmental outcomes and longer cardiac intensive care unit stays.