Dear Editor,

We read with great interest the paper of Vural et al. on the cardiac effects of single course antenatal betamethasone therapy in preterm infants [1]. In line with the observations of Dimitriou et al on the impact of betamethasone on neonatal renal function in this journal, there is still need to further document the impact of antenatally administered steroids on various extrapulmonary outcome variables like cardiovascular stability [2]

We therefore would like to report on the use of dopamine in the first week of life in a cohort of 282 consecutively admitted low birth weight infants (i.e. < 1500g) of whom 243 survived until discharge. Our algorithm to initiate dopamine has recently been described [3]

Data on betamethasone were not retrieved in 6 cases, resulting in observations in 237 LBW survivors. The clinical characteristics of LBW infants either (n = 178) or not treated (n = 59) before birth with betamethasone can be summarized as follows[betamethasone /no betamethasone]: Number= 178/59, Gestational age(wks)= 29(24-34)/30(24-35)(NS), Birth weight(g)= 1142(SD 272)/1062(SD 303)(NS), CRIB score = 2 (0-13)/2(0-13)(NS), Inotropics < day 7 = 38 %/46 %(NS), duration inotropics, first wk (h)* 0(0–168)/0(0–144)(NS) duration inotropics, wk (h)** 50 (4–168)/56(8-144)(NS)

[* all survivors included, **only LBW infants treated with inotropics].

In brief, we were not able to document any difference in the administration or duration of administration of inotropics in the first week of life in LBW infants.

There is still uncertainty on the impact of prenatal steroids on various extra-pulmonary outcome variables. Since the positive effect of maternal administration of steroids on neonatal respiratory distress syndrome was repeatedly demonstrated, a randomized controlled trial approach to assess the impact of prenatal steroids on these extra- pulmonary outcome variables is no longer ethical or feasible. However, prospective collection of these variables like both above mentioned groups did, is still of clinical relevance especially if we take into account that the large RCT studies were performed in 80’ies and 90’ies and therefore, potentially only in part reflect the populations admitted in our units.

K Allegaert, MD PhD
Neonatal Intensive Care Unit
Division of Woman and Child
University Hospital, Gasthuisberg
Herestraat 49, 3000 Leuven, Belgium
E-mail: karel.allegaert@uz.kuleuven.ac.be

The clinical research of K Allegaert is supported by the Fund for Scientific Research, Flanders (Belgium) by a Clinical Doctoral Grant (A 6/5 – KV – G 1)

References

1.Vural M, Yilmaz I, Oztunc F, et al. Cardiac effects of single course antenatal betamethasone therapy in preterm infants. Arch Dis Child Fetal Neonatal Ed DOI 10.1136/adc.2005.084525

2.Dimitriou G, Kavvadia V, Marcou M, et al. Antenatal steroids and fluid balance in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2005;90:F509-13.

3.Allegaert K, Debeer A, Cossey V, et al. Dopamine is not an independent risk factor for reduced amikacin clearance in extremely low birth weight infants. Pediatr Crit Care Med 2006; DOI 10.1097/01.PCC.0000200971.65255.F0