Lung injury after neonatal congenital cardiac surgery is mild and modifiable by corticosteroids

Abstract Objective The present study aimed to determine whether lung injury manifests as lung edema in neonates after congenital cardiac surgery and whether stress-dose corticosteroid (SDC) regimen attenuates postoperative lung injury in neonates after congenital cardiac surgery. Design A supplementary report of a randomized, double-blinded, placebo-controlled clinical trial. Setting A pediatric tertiary university hospital. Participants Forty neonates (age ≤28 days) undergoing congenital cardiac surgery with cardiopulmonary bypass. Interventions After anesthesia induction, patients were randomized to receive intravenously either a 2 mg/kg methylprednisolone or placebo, which was followed by hydrocortisone or placebo for five days as follows: 0.2 mg/kg/h 6–48 hours postoperatively, 0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24 hours. Measurements and Main Results Chest radiography lung edema score was lower in the SDC than in the placebo group on the first postoperative day (POD1) (p=0.03) and on POD2-3 (p=0.03). Further, a modest increase in edema score of 0.9 was noted in the placebo group, meanwhile edema score remained at preoperative level in SDC group. Postoperative dynamic respiratory system compliance (Crs) was higher in the SDC group until POD3 (p Conclusions The SDC regimen reduced the development of mild and likely clinically insignificant radiographic lung edema and improved postoperative dynamic Crs without adverse events, but it failed to improve postoperative oxygenation and length of mechanical ventilation.