{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:21:16Z","timestamp":1760955676626},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T00:00:00Z","timestamp":1477353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008333","name":"University of Alabama at Birmingham","doi-asserted-by":"publisher","award":["35233"],"award-info":[{"award-number":["35233"]}],"id":[{"id":"10.13039\/100008333","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cardiopulmonary bypass (<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content>) may lead to adrenal insufficiency (<jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content>). Emerging evidence supports association of <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> with morbidity after cardiac surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this study was to define <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> incidence in neonates undergoing complex cardiac surgery with <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> and its association with intraoperative post\u2010<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty subjects enrolled in a prior randomized control trial who received preoperative methylprednisolone as part of our institutional neonatal bypass protocol were included. No intraoperative steroids were given. <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> stimulation tests were performed: preoperatively and 1 h after separation from <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> was defined as &lt;9 \u03bcg\u00b7ml<jats:sup>\u22121<\/jats:sup> increase in cortisol at 30 min post cosyntropin 1 mcg. Clinical outcomes were collected up to 90 min after <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>2\/40 (5%) subjects had preoperative <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> vs 13\/40 (32.5%) post\u2010<jats:styled-content style=\"fixed-case\">CPB AI<\/jats:styled-content>,<jats:italic> P<\/jats:italic> \u2264 0.001. No significant difference was observed in age, gestational age, weight, <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> time, circulatory arrest, or <jats:styled-content style=\"fixed-case\">STAT<\/jats:styled-content> category between subjects with or without post\u2010<jats:styled-content style=\"fixed-case\">CPB AI<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> decreased from preoperative values 127.3 vs 35 pcg\u00b7ml<jats:sup>\u22121<\/jats:sup> [median difference = 81.8, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 22.7\u2013127.3], while cortisol increased from 18.9 vs 75 \u03bcg\u00b7dl<jats:sup>\u22121<\/jats:sup> [median difference = 52.2, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 36.3\u201370.9]. Post\u2010<jats:styled-content style=\"fixed-case\">CPB AI<\/jats:styled-content> was associated with increased median colloid resuscitation, 275 vs 119 ml\u00b7kg<jats:sup>\u22121<\/jats:sup> [median difference = 97.8, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 7.1\u2013202.2]; higher median peak lactate, 9.4 vs 6.9 mg\u00b7dl<jats:sup>\u22121<\/jats:sup> [median difference = 3.2, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 0.04\u20136.7]; median post\u2010<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> lactate, 7.9 vs 4.3 mg\u00b7dl<jats:sup>\u22121<\/jats:sup>, [median difference 3.6, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 2.1\u20134.7], and median lactate on admission to <jats:styled-content style=\"fixed-case\">CICU<\/jats:styled-content>, 9.4 vs 6.0 mg\u00b7dl<jats:sup>\u22121<\/jats:sup> [median difference = 3, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 1.1\u20134.9]. No difference was observed in blood pressure or vasoactive inotrope score at any time point measured in operating room (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>). Higher initial post\u2010<jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> cortisol correlated with decreased cosyntropin response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neonatal cardiac surgery with <jats:styled-content style=\"fixed-case\">CPB<\/jats:styled-content> and preoperative methylprednisolone leads to <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> as determined by low\u2010dose ACTH stimulation test in one\u2010third of patients. <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> is associated with increased serum lactate and colloid resuscitation in <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>. Impact of preoperative methylprednisolone on results is not defined. Benefit of postoperative steroid administration in neonates with post\u2010<jats:styled-content style=\"fixed-case\">CPB AI<\/jats:styled-content> warrants further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13013","type":"journal-article","created":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T12:13:01Z","timestamp":1477397581000},"page":"77-84","source":"Crossref","is-referenced-by-count":18,"title":["Adrenal insufficiency in neonates after cardiac surgery with cardiopulmonary bypass"],"prefix":"10.1111","volume":"27","author":[{"given":"Jack H.","family":"Crawford","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Division of Congenital Cardiac Anesthesiology University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew S.","family":"Hull","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Division 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Wall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Section of Pediatric Cardiac Critical Care University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Alten","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Section of Pediatric Cardiac Critical Care University of Alabama at Birmingham Birmingham AL 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