Prophylactic Steroids For Pediatric Open Heart Surgery: A Systematic Review

Objectives To systematically review the beneficial and harmful effects of the prophylactic administration of corticosteroids,compared with placebo,in pediatric open heart surgery.Methods The following databases were searched:MBASE(1974-2008.12),Cochrane library(4 issue,2008),PubMed(1966-2008.12),Chinese Biomedical Literature Database (CBMWEB)(1978-2008.12),Chinese Scientific Journals Fulltext Database(CSJD) (1989-2008.12),China Journal Fulltext Database(CJFD)(1994-2008.12) et al; Web information of unpublished trials were searched by hand-searching reference lists and abstracts of conference proceedings and nephrology scientific meetings and Google and Medical Martix;We hand searched some important Chinese journals.Grey literature was searched and experts in the field were contacted for any unpublished material.No language restrictions were applied.All randomized and quasi-randomized controlled trials of open heart surgery in the pediatric population that received corticosteroids pre-,peri- or post-operatively,with reported clinical outcomes in terms of morbidity and mortality. Eligible studies were abstracted and evaluated by two independent reviewers.All meta-analyses were completed using RevMan4.2.8.Results All cause mortality could not be assessed as the data reports were incomplete. There was weak evidence in favor of prophylactic corticosteroid administration for reducing intensive care unit stay,peak core temperature and duration of ventilation WMD (95%CI) -0.50(-1.41 to 0.41);-0.20(-1.16 to 0.77) and -0.63(-4.01 to 2.75), respectively.Conclusions The use of prophylactic steroids in pediatric patients to reduce postoperative complications commonly experienced following cardiopulmonary bypass surgery is not supported by the existing evidence.Further well designed and adequately powered randomized controlled trials are needed to more accurately estimate the benefit and harm of this intervention.