PMID- 33864754 OWN - NLM STAT- MEDLINE DCOM- 20220525 LR - 20230602 IS - 1552-6259 (Electronic) IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 113 IP - 6 DP - 2022 Jun TI - Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery. PG - 2079-2084 LID - S0003-4975(21)00697-4 [pii] LID - 10.1016/j.athoracsur.2021.04.006 [doi] AB - 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. CI - Copyright (c) 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Zyblewski, Sinai C AU - Zyblewski SC AD - Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. Electronic address: chois@musc.edu. FAU - Martin, Renee H AU - Martin RH AD - Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina. FAU - Shipes, Virginia B AU - Shipes VB AD - Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina. FAU - Hamlin-Smith, Kasey AU - Hamlin-Smith K AD - Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. FAU - Atz, Andrew M AU - Atz AM AD - Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. FAU - Bradley, Scott M AU - Bradley SM AD - Section of Pediatric Cardiac Surgery, Medical University of South Carolina, Charleston, South Carolina. FAU - Kavarana, Minoo N AU - Kavarana MN AD - Section of Pediatric Cardiac Surgery, Medical University of South Carolina, Charleston, South Carolina. FAU - Mahle, William T AU - Mahle WT AD - Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia. FAU - Everett, Allen D AU - Everett AD AD - Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland. FAU - Graham, Eric M AU - Graham EM AD - Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. LA - eng GR - R01 HL112968/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial DEP - 20210420 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R RN - 0 (Biomarkers) RN - X4W7ZR7023 (Methylprednisolone) SB - IM MH - Biomarkers MH - *Brain Injuries MH - *Cardiac Surgical Procedures/adverse effects MH - Humans MH - Infant MH - Infant, Newborn MH - Methylprednisolone/therapeutic use MH - *Neurodevelopmental Disorders/epidemiology/etiology MH - Prognosis PMC - PMC8514577 MID - NIHMS1693819 EDAT- 2021/04/18 06:00 MHDA- 2022/05/26 06:00 PMCR- 2023/06/01 CRDT- 2021/04/17 20:06 PHST- 2020/12/18 00:00 [received] PHST- 2021/03/03 00:00 [revised] PHST- 2021/04/05 00:00 [accepted] PHST- 2021/04/18 06:00 [pubmed] PHST- 2022/05/26 06:00 [medline] PHST- 2021/04/17 20:06 [entrez] PHST- 2023/06/01 00:00 [pmc-release] AID - S0003-4975(21)00697-4 [pii] AID - 10.1016/j.athoracsur.2021.04.006 [doi] PST - ppublish SO - Ann Thorac Surg. 2022 Jun;113(6):2079-2084. doi: 10.1016/j.athoracsur.2021.04.006. Epub 2021 Apr 20.