Steroids Fail to Deliver Clear Benefits in Infant Heart Surgery
The decades-old question of whether steroids should be used in infants undergoing heart surgery to reduce inflammation from cardiopulmonary bypass remains unanswered, despite the heft of the largest pediatric heart surgery trial to date.
Results from the STRESS trial, which included 1200 babies yet to reach their first birthday, show perioperative methylprednisolone did not reduce the likelihood of a ranked composite of outcomes including operative death, heart transplantation, and 13 other major complications compared with placebo after covariate adjustment (adjusted odds ratio [OR] 0.86; 95% CI, 0.71 - 1.05).
@nirdesh There was no difference in the primary endpoint components of operative mortality (2% methylprednisolone group vs 2.8% placebo), a composite of mortality and major complications (17.2% vs 20.3%), and prolonged mechanical ventilation (6.8% vs 8.5%).
Babies who received methylprednisolone were also more likely to have high blood glucose levels, a known stress response to surgery, with 19% requiring postoperative insulin vs 6.7% with placebo (P < .001), according to results published November 6 in the New England Journal of Medicine.