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Perinatal Glucocorticoid Therapy and Cardiovascular Follow-up

Willem B. de Vries, MD, PhD; Rosa Karemaker, MD, PhD; Nicole F. Mooy; Jan L. M. Strengers, MD, PhD; Hans Kemperman, MD, PhD; Wim Baerts, MD, PhD; Sylvia Veen, MD, PhD; Gerard H. A. Visser, MD, PhD; Cobi J. Heijnen, PhD; Frank van Bel, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(8):738-744.

Objective  To study whether antenatal or neonatal glucocorticoid therapy to reduce the incidence and severity of chronic lung disease in preterm infants is associated with long-term adverse cardiac effects and hypertension.

Design  Retrospective matched-cohort study.

Setting  Outpatient clinic of a tertiary care hospital.

Participants  One hundred ninety-three children aged 7 to 10 years who had been born prematurely between December 2, 1993, and September 15, 1997.

Main Exposure  Neonatal treatment with dexamethasone disodium phosphate(n = 48) or the clinically equally effective glucocorticoid hydrocortisone (n = 51), or only antenatal treatment with betamethasone disodium phosphate and betamethasone acetate (n = 51). These 3 groups were compared with a reference group of prematurely born children who had not been exposed to perinatal glucocorticoid therapy (n = 43).

Main Outcome Measures  General hemodynamic data (heart rate and blood pressure), cardiovascular function as assessed at echocardiography, intima-media thickness of the carotid arteries, and cardiac biochemical features as early markers of expansion and volume overload of the cardiac left ventricle (B-type natriuretic peptide and N-terminal pro–B-type natriuretic peptide).

Results  No significant group differences were found for heart rate, blood pressure, biochemical features, intima-media thickness, or systolic or diastolic left ventricular function.

Conclusions  Although no differences were found in blood pressure and cardiovascular function at school age in children antenatally or neonatally treated with glucocorticoids, further cardiovascular follow-up may be advisable because cardiovascular dysfunction may become apparent only later in life.

Author Affiliations: Departments of Neonatology (Drs de Vries, Karemaker, and van Bel), Pediatric Cardiology (Ms Mooy and Dr Strengers), Clinical Chemistry and Haematology (Dr Kemperman), and Obstetrics (Dr Visser), and Laboratory for Psychoneuroimmunology (Drs Karemaker and Heijnen), University Medical Center Utrecht, Utrecht; Department of Neonatology, Isala Clinics, Zwolle (Dr Baerts); and Department of Neonatology, University Medical Center Leiden, Leiden (Dr Veen); the Netherlands.

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