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Triiodothyronine Supplementation for Children Undergoing Cardiopulmonary Bypass: A Meta-Analysis

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Abstract

Specific pediatric populations have exhibited disparate responses to triiodothyronine (T3) repletion during and after cardiopulmonary bypass (CPB). Objective: To determine if T3 supplementation improves outcomes in children undergoing CPB. We searched randomized controlled trials (RCT) evaluating T3 supplementation in children aged 0–3 years undergoing CPB between 1/1/2000 and 1/31/2022. We calculated Hazard ratios (HR) for time to extubation (TTE), ICU length of stay (LOS), and hospital LOS. 5 RCTs met inclusion criteria with available patient-level data. Two were performed in United States (US) and 3 in Indonesia with 767 total subjects (range 29- 220). Median (IQR) age 4.1 (1.6, 8.0) months; female 43%; RACHS-1 scores: 1–1%; 2–55%; 3–27%; 4–13%; 5–0.1%; 6–3.9%; 54% of subjects in US vs 46% in Indonesia. Baseline TSH and T3 were lower in Indonesia (p < 0.001). No significant difference occurred in TTE between treatment groups overall [HR 1.09 (CI, 0.94–1.26)]. TTE numerically favored T3-treated patients aged 1–5 months [HR 1.24 (CI, 0.97–1.60)]. TTE HR for the Indonesian T3 group was 1.31 (CI, 1.04–1.65) vs. 0.95 (CI, 0.78–1.15) in US. The ICU LOS HR for the Indonesian T3 group was 1.19 vs. 0.89 in US (p = 0.046). There was a significant T3 effect on hospital LOS [HR 1.30 (CI, 1.01–1.67)] in Indonesia but not in US [HR 0.99 (CI, 0.78–1.23)]. T3 supplementation in children undergoing CPB is simple, inexpensive, and safe, showing benefit in resource-limited settings. Differences in effects between settings likely relate to depression in baseline thyroid function often associated with malnutrition.

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Authors and Affiliations

  1. Division of Cardiac Critical Care, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, 4800 Sand Point Way NE, RC.2.820, Seattle, WA, 98105, USA

    Monique R. Radman

  2. New Arch Consulting, Issaquah, WA, USA

    April E. Slee

  3. Division of Pediatric Cardiac Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

    Eva M. Marwali

  4. Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Michael A. Portman

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  1. Monique R. Radman
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Contributions

MR, AS, EM and MP: conceptualization; MR, AS and MP: methodology; MR, AS and MP: formal analysis and investigation; MR, AS and MP: writing - original draft preparation; MR, EM, AS and MP - review and editing; MR and MP - supervision.

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Correspondence to Monique R. Radman.

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Radman, M.R., Slee, A.E., Marwali, E.M. et al. Triiodothyronine Supplementation for Children Undergoing Cardiopulmonary Bypass: A Meta-Analysis. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03465-1

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