• Anu K Kaskinen, Juho Keski-Nisula, Laura Martelius, Eeva Moilanen, Mari Hämäläinen, Paula Rautiainen, Sture Andersson, and Olli M Pitkänen-Argillander.
• Division of Pediatric Nephrology and Transplantation, Children's Hospital and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: anu.kaskinen@helsinki.fi.
• J. Cardiothorac. Vasc. Anesth. 2021 Jul 1; 35 (7): 2100-2107.

ObjectivesThe present study was performed to determine whether lung injury manifests as lung edema in neonates after congenital cardiac surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates postoperative lung injury in neonates after congenital cardiac surgery.DesignA supplementary report of a randomized, double-blinded, placebo-controlled clinical trial.SettingA pediatric tertiary university hospital.ParticipantsForty neonates (age ≤28 days) undergoing congenital cardiac surgery with cardiopulmonary bypass.InterventionsAfter anesthesia induction, patients were assigned randomly to receive intravenously either 2 mg/kg methylprednisolone or placebo b, which was followed by hydrocortisone or placebo bolus six hours after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours, 0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24 hours.Measurements And Main ResultsThe chest radiography lung edema score was lower in the SDC than in the placebo group on the first postoperative day (POD one) (p = 0.03) and on PODs two and three (p = 0.03). Furthermore, a modest increase in the edema score of 0.9 was noted in the placebo group, whereas the edema score remained at the preoperative level in the SDC group. Postoperative dynamic respiratory system compliance was higher in the SDC group until POD three (p < 0.01). However, postoperative oxygenation; length of mechanical ventilation; and tracheal aspirate biomarkers of inflammation and oxidative stress, namely interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no differences between the groups.ConclusionsThe SDC regimen reduced the development of mild and likely clinically insignificant radiographic lung edema and improved postoperative dynamic respiratory system compliance without adverse events, but it failed to improve postoperative oxygenation and length of mechanical ventilation.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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