Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass

• Published in: Cochrane database of systematic reviews 2020-10, Vol.10 (10), p.CD013101
• Main Authors: Gibbison, Ben, Villalobos Lizardi, José Carlos, Avilés Martínez, Karla Isis, Fudulu, Daniel P, Medina Andrade, Miguel Angel, Pérez-Gaxiola, Giordano, Schadenberg, Alvin Wl, Stoica, Serban C, Lightman, Stafford L, Angelini, Gianni D, Reeves, Barnaby C
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Bias; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - mortality; Cause of Death; Child; Child health; Child, Preschool; Dexamethasone - therapeutic use; Heart & circulation; Heart-Lung Machine - adverse effects; Hospital Mortality; Humans; Hydrocortisone - therapeutic use; Infant; Infant, Newborn; Inflammation - etiology; Inflammation - prevention & control; Intensive Care Units, Pediatric - statistics & numerical data; Length of Stay; Methylprednisolone - therapeutic use; P. Congenital Heart Abnormalities; Randomized Controlled Trials as Topic; Respiration, Artificial - statistics & numerical data
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD013101.pub2

Corticosteroids are routinely given to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) in an attempt to ameliorate the inflammatory response. Their use is still controversial and the decision to administer the intervention can vary by centre and/or by individual doctors within that centre. This review is designed to assess the benefits and harms of prophylactic corticosteroids in children between birth and 18 years of age undergoing cardiac surgery with CPB. We searched CENTRAL, MEDLINE, Embase and Conference Proceedings Citation Index-Science in June 2020. We also searched four clinical trials registers and conducted backward and forward citation searching of relevant articles. We included studies of prophylactic administration of corticosteroids, including single and multiple doses, and all types of corticosteroids administered via any route and at any time-point in the perioperative period. We excluded studies if steroids were administered therapeutically. We included individually randomised controlled trials (RCTs), with two or more groups (e.g. multi-drug or dose comparisons with a control group) but not 'head-to-head' trials without a placebo or a group that did not receive corticosteroids. We included studies in children, from birth up to 18 years of age, including preterm infants, undergoing cardiac surgery with the use of CPB. We also excluded studies in patients undergoing heart or lung transplantation, or both; studies in patients already receiving corticosteroids; in patients with abnormalities of the hypothalamic-pituitary-adrenal axis; and in patients given steroids at the time of cardiac surgery for indications other than cardiac surgery. We used the Covidence systematic review manager to extract and manage data for the review. Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We resolved disagreements by consensus or by consultation with a third review author. We assessed the certainty of evidence with GRADE. We found 3748 studies, of which 888 were duplicate records. Two studies had the same clinical trial registration number, but reported different populations and interventions. We therefore included them as separate studies. We screened titles and abstracts of 2868 records and reviewed full text reports for 84 studies to determine eligibility. We extracted data for 13 studies. Pooled analyses are based on eight studies. We reported the remaining five studies