Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial Pertti K. Suominen, MD, PhD, Juho Keski-Nisula,

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Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial Pertti K. Suominen, MD, PhD, Juho Keski-Nisula,

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Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial Pertti K. Suominen, MD, PhD, Juho Keski-Nisula, MD, Tiina Ojala, MD, PhD, Paula Rautiainen, MD, PhD, Timo Jahnukainen, MD, PhD, Johanna Hästbacka, MD, PhD, Pertti J. Neuvonen, MD, PhD, Olli Pitkänen, MD, PhD, Jussi Niemelä, MD, PhD, Anu Kaskinen, MD, Jukka Salminen, MD, PhD, Risto Lapatto, MD, PhD The Annals of Thoracic Surgery Volume 104, Issue 4, Pages 1378-1385 (October 2017) DOI: 10.1016/j.athoracsur.2017.01.111 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The mean ± SD plasma concentrations of (A) interleukin (IL)-6, (B) IL-10, (C) C-reactive protein (CRP), and (D) white blood cell count collected preoperatively (T1), at 0 (T2) and 6 (T3) hours after cardiopulmonary bypass, and during postoperative days 1 to 5 (T4 to 8) in the stress-dose corticosteroid (SDC) and placebo groups. *p < 0.05 and **p < 0.001 indicate a significant difference between the groups. The Annals of Thoracic Surgery 2017 104, 1378-1385DOI: (10.1016/j.athoracsur.2017.01.111) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The (A) inotropic score, (B) plasma lactate, and (C) central venous saturation (Svo2) values (means ± SD) in the stress-dose corticosteroid (SDC) and placebo groups on the pediatric intensive care unit (PICU) arrival, 6 hours after cessation of cardiopulmonary bypass (CPB), and on postoperative days (PODs) 1 to 6. ∗p < 0.05 and ∗∗p < 0.001 indicate a significant difference between the study groups. The Annals of Thoracic Surgery 2017 104, 1378-1385DOI: (10.1016/j.athoracsur.2017.01.111) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Plasma concentrations (means ± SD) of methylprednisolone in 20 neonates in the stress-dose corticosteroid group (SDC) undergoing cardiac operations after the intravenous administration of methylprednisolone (2 mg/kg). The time points: T1, after induction of anesthesia; T2, after weaning from cardiopulmonary bypass (CBP); T3, 6 hours after cessation of CPB; and T4, at the first postoperative morning. The Annals of Thoracic Surgery 2017 104, 1378-1385DOI: (10.1016/j.athoracsur.2017.01.111) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Plasma cortisol concentrations (means ± SD) in neonates receiving stress-dose cortisone (SDC; n = 20) or placebo (n = 20) intraoperatively and postoperatively. The time-points: T1, after induction of anesthesia; T2, after weaning from cardiopulmonary bypass (CBP); T3, 6 hours after cessation of CPB; and T4 to T8, in the following 5 postoperative days. The Annals of Thoracic Surgery 2017 104, 1378-1385DOI: (10.1016/j.athoracsur.2017.01.111) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions