Cerebral haemodynamics in preterm infants after exposure to dexamethasone
a Division of Neonatology,
La Paz Children's Hospital, 28046 Madrid, Spain, b Division
of Neonatology, Department of Pediatrics, Aker Hospital, Oslo, Norway
Correspondence to: Dr Adelina Pellicer.
Accepted 16 February
1998
AIM
To determine changes in brain
haemodynamics produced by dexamethasone; to evaluate the
pathophysiological conditions involved in the effect of dexamethasone.
METHODSA prospective study was made of 12 ventilated preterm infants who received dexamethasone (0.25 mg/kg/12
hours) for ongoing chronic lung disease or extubation failure. Cerebral
blood flow (CBF), absolute cerebral blood volume (CBV), and cerebral
blood volume changes (
CBV) were estimated by near infrared
spectroscopy, before and 10, 30, 60, 120, 180 and 240 minutes after the
first, third, and fifth doses of dexamethasone. All patients were
monitored continuously using pulse oximetry, transcutaneous blood
gases, and blood pressure.
RESULTSThere were significant short term changes
in CBV on each day of the study; CBV increased significantly at
240 minutes compared with values before the first dose, and from 120 minutes onward during the third and fifth doses. However, mean CBV
values averaged over 240 minutes after the first, third, and fifth
doses did not vary. Mean CBF values averaged over 240 minutes increased
progressively up to the fifth dose (significant differences between the
first and fifth dose). The short term changes in CBF consisted of a significant increase 60 minutes after dexamethasone administration compared with the before and 10 minute values in every study. Blood
pressure was significantly higher in the third and fifth doses than in
the first dose. Blood pressure showed no short term changes. There was
no correlation between CBF and blood pressure changes.
TcPCO2 (transcutaneous PCO2) decreased
significantly throughout the study period, with the average mean value
in the fifth dose significantly lower than in the first dose.
Nevertheless, no short term changes in TcPCO2
were observed.
CONCLUSIONSPostnatal systemic
dexamethasone administration produced significant changes in cerebral
haemodynamics that seemed to be related to both a direct effect on
regional vessel walls and the cumulative effect of dexamethasone.
© 1998 by Archives of Disease in Childhood
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