The efficacy of perioperative steroid therapy in pediatric primary palatoplasty

Objective: To determine if perioperative steroid therapy benefits pediatric primary palatoplasty patients. Design: A prospective, double-blind, randomized trial with a placebo contro l, Setting: An academic medical center. Patients: Forty-five children undergoing primary repair of their cleft pala te between 1989 and 1996 who were under the age of 48 months and without de velopmental delay or any associated syndrome. Interventions: Intravenous dexamethasone sodium phosphate (0.25 mg/kg) or a placebo (5% dextrose in water) immediately preoperatively and once every 8 hours for two doses postoperatively. Main outcome measures: Postoperative airway distress, fever, oral fluid int ake, discharge eligibility, and palatal fistula formation, Results: Perioperative steroid therapy significantly reduced the incidence of postoperative airway distress (p =.05) and postoperative fever (p =.02); postoperative oral fluid intake, discharge eligibility, and palatal fistul a formation were not significantly affected, Conclusions: Perioperative steroids effectively lower the risk of postopera tive airway distress and postoperative fever in children undergoing the pri mary repair of their cleft palate. This finding favors a customary role for perioperative steroid therapy in pediatric primary palatoplasty.