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Serum Cortisol and Early Postoperative Outcome After Stage-1 Palliation for Hypoplastic Left Heart Syndrome

Bangalore, Harish MBBS, MRCPCh1; Ocampo, Elena C. MD2; Rodriguez, Luisa M. MD3; Minard, Charles G. PhD4; Checchia, Paul A. MD, FAAP, FCCM, FACC2; Heinle, Jeffrey S. MD5,6; Shekerdemian, Lara S. MBChB, MD, FRACP, MHA1

Pediatric Critical Care Medicine: March 2014 - Volume 15 - Issue 3 - p 211–218
doi: 10.1097/PCC.0000000000000050
Cardiac Intensive Care

Objectives: The postoperative cortisol profile and its association with early outcomes are poorly understood in neonates undergoing surgery for complex congenital heart disease. We investigated the postoperative profile of cortisol and its relationship with the clinical course in a cohort of newborns after stage-1 palliation for hypoplastic left heart syndrome.

Design: Prospective observational study.

Setting: Pediatric cardiovascular ICU at a tertiary children’s hospital.

Subjects: Twenty-three neonates after stage-1 palliation for hypoplastic left heart syndrome between 2009 and 2011.

Interventions: None.

Measurements and Main Results: Three serial measurements of total serum cortisol after surgery. The first measurement was taken immediately after surgery and the second and third—on the first and second postoperative mornings. The median weight of the infants was 3.0 kg (2.7–3.4 kg), and the age at surgery was 7 days (6–9 d). The median (25th–75th percentile) cortisol levels at admission, day 1, and day 2 were 96.2 μg/dL (51.1–112 μg/dL), 17.3 μg/dL (9.7–25.1 μg/dL), and 10 μg/dL (6.5–17 μg/dL), respectively (p < 0.0001 between admission and day 1). Higher cortisol was associated with greater morbidity, including the need for preoperative ventilation, increased total duration of ventilation, duration of inotropic support, and hospital length of stay.

Conclusions: Cortisol levels fell significantly over the first 24 hours after stage-1 palliation for hypoplastic left heart syndrome. A higher postoperative cortisol was associated with increased postoperative morbidity, which warrants further investigation.

1Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

2Department of Pediatrics, Section of Cardiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

3Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

4Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX.

5Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.

6Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, TX.

Supported, in part, by the Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX.

Dr. Minard is employed at Baylor College of Medicine as a faculty member in the Institute for Clinical and Translational Research. Dr. Checchia lectured for Abbott and Medimmune. His institution received grant support from Ikaria. The remaining authors disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: lssheker@texaschildrens.org

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies