Effects of N-acetylcysteine on renal dysfunction in neonates undergoing the arterial switch operation

The Journal of Thoracic and Cardiovascular Surgery
Ranjit AiyagariJohn R Charpie

Abstract

We evaluated N-acetylcysteine, a potent antioxidant, as prevention for renal dysfunction in infants undergoing cardiac surgery for dextro-transposition of the great arteries. Twenty-one neonates undergoing the arterial switch operation were randomized to receive either placebo or intravenous N-acetylcysteine. Serial data were collected on fluid balance, serum creatinine, inotropic support, cardiac output, and length of stay. Hospital and 30-day survival was 100%. No serious adverse events were attributable to the drug. Subjects treated with N-acetylcysteine had a higher urine output at 24 hours (175 mL vs 96 mL; P < .01) and a shorter median time to first negative fluid balance (27 hours vs 39.5 hours; P = .02). There were no differences between groups in diuretic therapy, inotropic support, fluid intake, or chest tube output. Serum creatinine increased at 24 hours after the operation by a mean of 0.27 mg/dL with placebo (P < .01) but was unchanged with N-acetylcysteine treatment. By postoperative day 3, serum creatinine increased by 92% in the placebo group but only 38% in the N-acetylcysteine group (P = .04). Length of intensive care unit stay was shorter by an average of 5 days (P = .04) with N-acetylcysteine treatment. In t...Continue Reading

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Citations

Mar 24, 2011·Pediatric Research·Yun-Wen PengJohn R Charpie
Jul 19, 2011·The Journal of Surgical Research·Antonio Carlos SeguroMaria Heloisa M Shimizu
Jan 22, 2014·Congenital Heart Disease·George T NicholsonWilliam T Mahle
Jul 1, 2011·World Journal for Pediatric & Congenital Heart Surgery·David S CooperCatherine D Krawczeski
Oct 14, 2017·Current Opinion in Cardiology·Katja M GistDavid S Cooper
Jun 12, 2020·Journal of Cardiothoracic Surgery·Yun-Wen PengJohn R Charpie

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