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

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 thirdon 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 g/dL (51.1-112 g/dL), 17.3 g/dL (9.7-25.1 g/dL), and 10 g/dL (6.5-17 g/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.