Cardiac effects of short course dexamethasone in preterm infants
a Peter Congden Neonatal Intensive Care Unit, D
Floor Clarendon Wing, Leeds General Infirmary,
Leeds, LS2 9NS, b Killingbeck Hospital Leeds
Correspondence to: Dr R Skelton Hull Maternity Hospital, Hedon Road, Hull HU9 5LX.
Accepted 24 September 1997
AIM
To examine the incidence and
natural history of left ventricular hypertrophy (LVH) associated with
the shorter 2-3 week course of dexamethasone, now more usual, for
chronic lung disease.
METHODThirty one infants, gestational age 23-34
(median 26) weeks, birthweight 500-2054 (median 815)g, received
dexamethasone, starting at 0.4-0.6 mg/kg/day, at a median of 11 days
of age (range 2-34), weaning over a period of 2-3 weeks. Eighteen
preterm neonates were studied as controls over a similar time period.
Serial echocardiographic measurements of end diastolic interventricular
septum (IVSd) and left ventricular posterior wall (LVPWd) thicknesses
were taken before, and up to 48 days after, starting dexamethasone.
Maximum Doppler blood flow velocities from the left ventricular outflow tract (LVOT) were measured.
RESULTSLeft ventricular hypertrophy (LVH)
occurred in 29 babies (94%). Median hypertrophy of the IVSd in those
receiving dexamethasone was 67% and LVPWd 56% of baseline
measurements, significantly greater than control infants (p<0.001).
LVH appeared by a median of three days, peaking by a median of 10 days.
All resolved by a median of 27 days. LVOT obstruction was not seen.
There was no significant correlation with birthweight, gestation, blood pressure, or glucose tolerance.
CONCLUSIONSLVH developed in almost all
preterm neonates receiving a 2-3 week course of dexamethasone, but was
of little clinical importance and always resolved. Echocardiography is
probably not required routinely in infants receiving such short course
dexamethasone for chronic lung disease.
© 1998 by Archives of Disease in Childhood
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