Non-neurological, steroid-related adverse events in very low birth weight infants: a prospective audit.
OBJECTIVE
To assess the incidence of cardiac and metabolic adverse events in very low birth weight (VLBW) infants receiving systematic steroids.


METHODS
Prospective single centre audit in VLBW infants (<1,500 g) at the neonatal intensive care unit at the University Children's Hospital of Saarland, Germany.


RESULTS
A total of 72 VLBW infants (38 female) were included in this report (mean birth weight: 967 ± 338 g; range: 320-1490 g). Birth weight, gestational age and Apgar scores were significantly lower in the steroid group (p <0.01). Mortality rate was 8/72 (7/34 in the steroid treated vs nontreated 1/38; odds ratio [OR]: 9.6; 95% confidence interval [CI]: 1.1-82.6 p = 0.02). In 34/72 infants, steroids were given (22 hydrocortisone alone; 12 combination of hydrocortisone and dexamethasone). The most common indication for use of steroids was respiratory distress syndrome (RDS) and respiratory insufficiency (30/34). Adverse events that occurred more often in the steroid group included hypertrophic cardiomyopathy (14/34 vs 0/38; p <0.001); thrombus formation (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p <0.05), hyperglycaemia (27/34 vs 3/38; OR: 45.0; 95% CI: 10.6-190.4; p <0.01), hypernatraemia (15/34 vs 7/38; OR: 3.5; 95% CI: 1.2-10.1; p <0.05), and sepsis/infections (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p <0.05). No significant differences were seen between hydrocortisone alone and the combination of hydrocortisone with dexamethasone. Birth weight and severity of RDS were predictors of steroid use (p <0.01).


CONCLUSIONS
The use of steroids was significantly associated with severe short-term adverse events - most importantly hypertrophic cardiomyopathy and thrombus formation. These complications must be taken into consideration when administering steroids to VLBW infants.
University Hospital of Saarland, Medical School, Homburg, Germany.
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SB
Röhr
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H
Sauer
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S
Gottschling
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Abdul-Khaliq
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L
Gortner
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H
Nunold
S
S
Gräber
S
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Meyer
D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001034:Apgar Score; D001724:Birth Weight; D002312:Cardiomyopathy, Hypertrophic / Q000139:chemically induced; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects*; D006943:Hyperglycemia / Q000139:chemically induced; D006955:Hypernatremia / Q000139:chemically induced; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000188:drug therapy; D018805:Sepsis / Q000139:chemically induced; D012720:Severity of Illness Index; D013927:Thrombosis / Q000139:chemically induced
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D006854:Hydrocortisone