Abstract:

Objective To evaluate the effects of perioperative administration of methylprednisolone in pediatric patients undergoing cardiac surgery together with cardiopulmonary bypass. Methods Randomized controlled trials published in English language involving pediatric patients aged under 16 years undergoing cardiac surgery together with cardiopulmonary bypass, which prophylactic perioperative methylprednisolone administrated during cardiac surgery was compared with placebo or blank control were included.The PubMed, Embase, Medline,and the Cochrane Library were searched systematically up to May 2016. The search strategy was "methylprednisolone" AND "cardiopulmonary bypass" OR "CPB". The primary outcome to evaluate the efficacy of methylprednisolone in pediatric cardiac surgery with cardiopulmonary bypass was all-cause in-hospital mortality. The meta-analysis was performed by RevMan 5.3 software. A subgroup analysis about delivery method was made between intravenous administration before surgery (subgroup A) and CPB circuit in CPB prime(subgroup B)． Results Six RCTs with 486 patients were included into this meta-analysis, including 253 patients with methylprednisolone and 233 patients with placebo or blank control. Five RCTs reported the information of random sequence generation, 2 RCTs reported adequate information about allocation concealment. All of the included RCTs reported blinding of outcome assessment and described off or lost, 5 RCTs didn't report selective results, other bias were uncertain. Compared with placebo patients, methylprednisolone administration was associated with significant reduction of postoperative mortality (RR=0.22, 95% CI: 0.06 to 0.83, P = 0.03). The results of meta-analysis showed that the CPB time was decreased in experimental groups (MD=-10.67，95% CI：-17.82 to -3.53，Ｐ=0.003)，and similar trend was found in subgroup A，the MD(95%CI) was -0.72 (95%CI: -1.33 to -0.12, P=0.02)．There was no relation with decreased cross-clamp time, mechanical ventilation time and length of ICU stay in subgroup B. Conclusion Under the limited evidence, the delivery method of intravenous administration before surgery may be better than CPB circuit in CPB prime to decrease ICU stay and CPB time.