Preoperative use of steroids in pediatric cardiac surgery: new directions for future research?

After performing a prospective double blinded randomized study in neonates undergoing arterial switch operation, we suggested that myocardial protection was provided by preoperative dexa-methasone administration. Vitale and colleagues' [1] comment on our conclusions by pointing out the need of verifying the effect of preoperative dexamethasone in a large, randomized clinical trial. They base their comment on the fact that a multicenter observational analysis did not provide any significant beneficial effect of preoperative dexamethasone administration [2].