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Effect of dexamethasone on blood pressure--relationship to postnatal age
1Department of Child Health, King's College Hospital, London, UK.
Insights
Dexamethasone treatment in preterm infants can significantly increase systolic blood pressure. Regular blood pressure monitoring is crucial for all infants receiving dexamethasone, regardless of treatment timing.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Clinical Research
Background:
- Dexamethasone is frequently used in very preterm infants.
- The impact of dexamethasone on blood pressure in neonates requires further investigation.
- Timing of dexamethasone administration may influence its effects.
Purpose of the Study:
- To investigate the relationship between dexamethasone treatment and blood pressure changes in very preterm infants.
- To compare the effects of early versus late dexamethasone treatment on blood pressure.
- To determine the necessity of regular blood pressure monitoring during dexamethasone therapy.
Main Methods:
- Retrospective analysis of two groups of very preterm infants receiving dexamethasone.
- Early treatment group: dexamethasone initiated at a median postnatal age of 17 days.
- Late treatment group: dexamethasone initiated at a median postnatal age of 50 days.
- Systolic blood pressure was measured at the start and during dexamethasone therapy.
Main Results:
- Infants in the late treatment group had significantly lower initial and peak systolic blood pressure compared to the early treatment group (P < 0.01).
- The change in systolic blood pressure (pre-treatment to peak) was similar between the early (median 38 mmHg) and late (median 34 mmHg) treatment groups.
- Dexamethasone administration led to a marked elevation in systolic blood pressure in both groups.
Conclusions:
- Dexamethasone can cause significant systolic blood pressure elevation in very preterm infants, even within the first four weeks of life.
- Regular blood pressure monitoring is essential for all infants receiving dexamethasone, irrespective of the postnatal age at initiation.
- These findings underscore the importance of vigilant cardiovascular monitoring during dexamethasone therapy in neonates.
Abstract:
The relationship of the change in blood pressure levels of very preterm infants treated with dexamethasone to postnatal age was investigated. Sixteen infants, median gestational age 26 weeks (range 23-33) (early treatment group), and 15 infants, median gestational age 26 weeks (range 24-32) (late treatment group) were recruited. Dexamethasone was administered at a median postnatal age of 17 days (range 3-26) and 50 days (range 29-112), respectively. The systolic blood pressure at the start of treatment and the maximum systolic blood pressure achieved during therapy were both significantly lower (P less than 0.01) in the early rather than the late treatment group. The change in blood pressure, however, that is, from the pre-treatment level to the maximum systolic blood pressure achieved during therapy, was similar in the two groups (median 38 mmHg, range 23-59 early treatment group and median 34 mmHg, range 16-66 late treatment group). We conclude that, even in the first 4 weeks of life, dexamethasone can cause a marked elevation of systolic blood pressure. As a consequence, regardless of the postnatal age at which dexamethasone is administered, blood pressure levels must be measured regularly.