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【medical-news】糖皮质激素对早产儿心率、BP不一定
August 28, 2008 — In premature infants, neonatal treatment of lung disease with dexamethasone or hydrocortisone and antenatal treatment with dexamethasone has no adverse effects on heart rate and blood pressure (BP), according to the results of a retrospective matched-cohort study reported in the August issue of the Archives of Pediatric & Adolescent Medicine.
"Neonatal glucocorticoid treatment, in particular, dexamethasone therapy, has been extensively used to prevent or reduce the incidence and severity of chronic lung disease," write Willem B. de Vries, MD, PhD, from University Medical Center Utrecht in Utrecht, the Netherlands, and colleagues. "However, several clinical studies have reported long term adverse effects of dexamethasone therapy in neonates....Little is known about cardiac function in school-aged children who were born prematurely and were treated antenatally and/or neonatally with glucocorticoids."
The goal of this study was to determine whether use of antenatal or neonatal glucocorticoids to decrease the incidence and severity of chronic lung disease in preterm infants is associated with long-term adverse cardiac effects and hypertension.
At an outpatient clinic of a tertiary care hospital, 193 children aged 7 to 10 years who had been born prematurely between December 2, 1993, and September 15, 1997, underwent cardiovascular evaluation. Of these children, 48 had received neonatal treatment with dexamethasone disodium phosphate, 51 had received neonatal treatment with glucocorticoid hydrocortisone, and 51 had received only antenatal treatment with betamethasone disodium phosphate. These 3 groups were compared with a control group of 43 children born prematurely who had not received perinatal glucocorticoid therapy.
Primary endpoints were heart rate, BP, cardiovascular function determined by echocardiography, carotid artery intima-media thickness, and cardiac biochemical features as early markers of expansion and volume overload of the cardiac left ventricle (B-type natriuretic peptide [BNP] and N-terminal pro–B-type natriuretic peptide [N-terminal pro-BNP]).
Heart rate, BP, biochemical features, intima-media thickness, and systolic or diastolic left ventricular function did not differ significantly between groups.
"Although no differences were found in BP 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," the study authors write.
Limitations of this study include cardiovascular factors determined in a nonstrained condition and echocardiographic investigations possibly not sensitive enough to diagnose cardiomyopathy early in life.
"Neonatal treatment with dexamethasone or hydrocortisone and antenatal treatment with betamethasone in children who had been born prematurely did not have adverse effects on heart rate and blood pressure, cardiovascular function, intima-media thickness of the carotid arteries, or cardiac biochemical markers for left ventricular function at age 7 to 10 years," the study authors write. "However, prolonged cardiac follow-up is recommended in children who were neonatally treated with glucocorticoids because animal studies show that the functional consequences of the structural myocardial abnormalities established during neonatal glucocorticoid therapy may become manifest only in adulthood."
The Catharijne Foundation and the Dirkzwager-Assink Fund from the University Medical Center Utrecht supported this study. The study authors have disclosed no relevant financial disclosures.
Arch Pediatr Adolesc Med. 2008;162:738-744
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作者:admin@医学,生命科学 2010-10-07 05:11
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