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

Objective: We evaluated N-acetylcysteine, a potent antioxidant, as prevention for renal dysfunction in infants undergoing cardiac surgery for dextro-transposition of the great arteries. Methods: 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. Results: 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. Conclusions: In this pilot study, perioperative treatment with N-acetylcysteine resulted in improved urine output, shorter time to negative fluid balance, and attenuation of the rise in creatinine. These effects of N-acetylcysteine may translate to improved outcomes for infants undergoing complex cardiac operations. (J Thorac Cardiovasc Surg 2010; 139: 956-61)