Cardiovascular follow-up at school age after perinatal glucocorticoid exposure in prematurely born children: perinatal glucocorticoid therapy and cardiovascular follow-up.
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.


METHODS
Retrospective matched-cohort study.


METHODS
Outpatient clinic of a tertiary care hospital.


METHODS
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).


METHODS
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.
de Vries
Willem B
WB
Department of Neonatology, Room KE.04.123.1, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands. w.b.devries-3@umcutrecht.nl
Karemaker
Rosa
R
Mooy
Nicole F
NF
Strengers
Jan L M
JL
Kemperman
Hans
H
Baerts
Wim
W
Veen
Sylvia
S
Visser
Gerard H A
GH
Heijnen
Cobi J
CJ
van Bel
Frank
F
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy*; D007363:Intensive Care Units, Neonatal; D008297:Male; D018743:Perinatal Care; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017539:Tunica Intima / Q000473:pathology
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D003907:Dexamethasone; D001623:Betamethasone; D006854:Hydrocortisone