Although current studies do not support the routine use of corticosteroids after cardiopulmonary bypass in pediatric patients, there is incomplete understanding of the potential hemodynamic contribution of postoperative critical illness-related corticosteroid insufficiency in the intensive care unit. By reviewing the available studies and underlying pathophysiology of these phenomena in critically ill neonates, we can identify a subset of patients that may benefit from optimal diagnosis and treatment of receiving postoperative steroids. A suggested algorithm used at our institution is provided as a guideline for treatment of this high-risk population.
DickersonHAChangAC. Steroids and low cardiac output syndrome after cardiac surgery in children. Pediatr Crit Care Med.2005;6(4):495-496.
2.
GarciaXBhuttaATDyamenahalliUImamuraMJaquissRDProdhanP. Adrenal insufficiency in hemodynamically unstable neonates after open-heart surgery. Congenit Heart Dis.2010;5(5):422-429.
3.
SasserWCRobertSMCarloWF, et al.Postoperative serum cortisol concentration and adrenal insufficiency in neonates undergoing open-heart surgery. World J Pediatr Congenit Heart Surg.2012;3(2):214-220.
4.
CrawfordJHHullMSBorasinoS, et al.Adrenal insufficiency in neonates after cardiac surgery with cardiopulmonary bypass. Paediatr Anaesth.2017;27(1):77-84.
5.
GibbisonBVillalobos LizardiJCAviles MartinezKI, et al.Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass. Cochrane Database Syst Rev.2020;2020(10):CD013101. doi:10.1002/14651858.CD013101.pub2
6.
PasqualiSKHallMLiJS, et al.Corticosteroids and outcome in children undergoing congenital heart surgery: analysis of the Pediatric Health Information Systems database. Circulation.2010;122(21):2123-2130.
7.
FernandezEFMontmanRWatterbergKL. ACTH and cortisol response to critical illness in term and late preterm newborns. J Perinatol.2008;28(12):797-802.
8.
FuduluDPGibbisonBUptonT, et al.Corticosteroids in pediatric heart surgery: myth or reality. Front Pediatr.2018;6:112. doi:10.3389/fped.2018.00112
9.
TangARosenfeldCRMikhaelMMcPhaulMJKochJD. Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids. J Perinatol.2019;39(5):640-647.
10.
WaldELPrezeEEickhoffJCBackerCL. The effect of cardiopulmonary bypass on the hypothalamic-pituitary-adrenal axis in children. Pediatr Crit Care Med.2011;12(2):190-196.
11.
FernandezESchraderRWatterbergK. Prevalence of low cortisol values in term and near-term infants with vasopressor-resistant hypotension. J Perinatol.2005;25(2):114-118.
12.
FernandezEFWatterbergKL. Relative adrenal insufficiency in the preterm and term infant. J Perinatol.2009;29(S2):S44-S49.
13.
Al-SofyaniKAUddinMSQulisyEAAl-RadiOO. Patterns and determinants of change in cortisol levels and thyroid function as a function of cardiac risk in children undergoing cardiac surgery. Int J Pediatr.2022;2022:6730666. doi:10.1155/2022/6730666
14.
GajarskiRJStefanelliCBGrazianoJNKacirotiNCharpieJRVazquezD. Adrenocortical response in infants undergoing cardiac surgery with cardiopulmonary bypass and circulatory arrest. Pediatr Crit Care Med.2010;11(1):44-51.
15.
GrahamEMBradleySM. First nights, the adrenal axis, and steroids. J Thorac Cardiovasc Surg.2017;153(5):1164-1166.
16.
PlumptonKRAndersonBJBecaJ. Thyroid hormone and cortisol concentrations after congenital heart surgery in infants younger than 3 months of age. Intensive Care Med.2010;36(2):321-328.
17.
MurphyTWHomewoodJMcCabeAHumphreysNWolfAR. Evidence of cortisol suppression in neonates after major cardiac surgery: is supplementation necessary?Pediatric Anesthesia.2006;16(12):1297-1297.
18.
RobertSMBorasinoSDabalRJClevelandDCHockKMAltenJA. Postoperative hydrocortisone infusion reduces the prevalence of low cardiac output syndrome after neonatal cardiopulmonary bypass. Pediatr Crit Care Med.2015;16(7):629-636.
19.
AnnaneDPastoresSMRochwergB, et al.Guidelines for the diagnosis and management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Crit Care Med.2017;45(12):2078-2088.
20.
MaedaTTakeuchiMTachibanaKNishidaTKagisakiKImanakaH. Steroids improve hemodynamics in infants with adrenal insufficiency after cardiac surgery. J Cardiothorac Vasc Anesth.2016;30(4):936-941.
21.
ShoreSNelsonDPPearlJM, et al.Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically ill infants with congenital heart disease. Am J Cardiol.2001;88(5):591-594.
22.
SuominenPKDickersonHAMoffettBS, et al.Hemodynamic effects of rescue protocol hydrocortisone in neonates with low cardiac output syndrome after cardiac surgery. Pediatr Crit Care Med.2005;6(6):655-659.
23.
BronickiRAFloresSLoombaRS, et al.Impact of corticosteroids on cardiopulmonary bypass induced inflammation in children: a meta-analysis. Ann Thorac Surg.2021;112(4):1363-1370.
24.
AndoMParkISWadaNTakahashiY. Steroid supplementation: a legitimate pharmacotherapy after neonatal open heart surgery. Ann Thorac Surg.2005;80(5):1672-1678; discussion 1678.
25.
LangerMModiBPAgusM. Adrenal insufficiency in the critically ill neonate and child. Curr Opin Pediatr.2006;18(4):448-453.
26.
WatterbergKL. Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol.2004;9(1):13-21.
27.
CooperMSStewartPM. Adrenal insufficiency in critical illness. J Intensive Care Med.2007;22(6):348-362.
28.
MackieASGauvreauKBoothKLNewburgerJWLaussenPCRothSJ. Hemodynamic correlates of serum cortisol in neonates after cardiopulmonary bypass. Pediatr Crit Care Med.2011;12(3):297-303.
29.
ChenDDuY. Analysis of perioperative corticosteroid therapy in children undergoing cardiac surgery: a systematic review and meta-analysis. Clin Cardiol.2023;46(6):607-614.
