Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery.
Intraoperative Methylprednisolone and Neurodevelopmental Outcomes in Infants After Cardiac Surgery.
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DOI：
10.1016/j.athoracsur.2021.04.006
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发表时间：
2022-06
期刊：
影响因子：
--
通讯作者：
Graham EM
中科院分区：
文献类型：
--
作者：
Zyblewski SC;Martin RH;Shipes VB;Hamlin-Smith K;Atz AM;Bradley SM;Kavarana MN;Mahle WT;Everett AD;Graham EM
神经发育障碍是危重先天性心脏病手术幸存者的一个重要后果。这项研究试图确定新生儿心脏手术中甲基强的松龙是否与12个月大的神经发育结局有关，并确定与神经发育结局相关的早期预后变量。对一项双中心、双盲、随机、安慰剂对照的术中甲基强的松龙用于新生儿心脏手术的试验进行了计划的二次分析。围手术期测量脑损伤生物标志物。在12个月龄时进行贝利婴幼儿发展量表III(BSID-III)。研究采用了两个样本t检验和广义线性模型。129名受试者(甲基强的松龙61例，安慰剂68例)。两组患者的BSID-III评分和脑损伤生物标志物水平均无显著差异。接受姑息性(与矫正)手术的参与者的BSID-III认知评分平均值(101±15比106±14，p=0.03)和运动评分(85±18比94±16，p<；0.01)较低。较长的呼吸时间与较低的运动评分相关。心脏重症监护病房(CICU)住院时间越长，认知、语言和运动评分越低。体外循环时间、主动脉阻断时间和深低温停循环时间与BSID-III评分无关。神经发育结果与术中甲基强的松龙或术中变量无关。接受新生儿姑息(与矫正)手术的参与者在1年后在CICU停留的时间更长，神经发育结果更差。这项工作表明，仅专注于手术期的干预可能与长期的神经发育益处无关。
Neurodevelopmental impairment is a significant consequence for survivors of surgery for critical congenital heart disease. This study sought to determine if 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. A planned secondary analysis of a two-center, double-blind, randomized, placebo-controlled trial of intraoperative methylprednisolone in neonates undergoing cardiac surgery was performed. A brain injury biomarker was measured perioperatively. 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. 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 the two treatment groups. Participants who underwent a palliative (vs. corrective) procedure had lower mean BSID-III cognitive (101±15 vs. 106±14, p=0.03) and motor scores (85±18 vs. 94±16, p<0.01). Longer ventilation time was associated with lower motor scores. Longer cardiac intensive care unit (CICU) 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. Neurodevelopmental outcomes were not associated with intraoperative methylprednisolone or intraoperative variables. Participants who underwent a neonatal palliative (vs. corrective) procedure had longer CICU 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.
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影响因子：
4.6
作者：
Heying, Ruth;Wehage, Edith;Seghaye, Marie-Christine
通讯作者：
Seghaye, Marie-Christine
DOI：
10.1016/j.jtcvs.2006.11.029
发表时间：
2007-04-01
影响因子：
6
作者：
Goldberg, Caren S.;Bove, Edward L.;Ohye, Richard G.
通讯作者：
Ohye, Richard G.
影响因子：
1
作者：
Bellinger, David C.;Newburger, Jane W.;Rappaport, Leonard A.
通讯作者：
Rappaport, Leonard A.
影响因子：
29
作者：
Papa L;Brophy GM;Welch RD;Lewis LM;Braga CF;Tan CN;Ameli NJ;Lopez MA;Haeussler CA;Mendez Giordano DI;Silvestri S;Giordano P;Weber KD;Hill-Pryor C;Hack DC
通讯作者：
Hack DC
DOI：
10.1097/pcc.0000000000000541
发表时间：
2016-01
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Elhoff JJ;Chowdhury SM;Zyblewski SC;Atz AM;Bradley SM;Graham EM
通讯作者：
Graham EM