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Dexamethasone given to premature infants and cardiac diastolic function in early childhood
Ivan H-B Wong1, Alyson M Digby, Andrew E Warren
1Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Dexamethasone treatment in premature infants with bronchopulmonary dysplasia did not lead to long-term cardiac diastolic dysfunction in childhood. Echocardiography showed normal heart function in treated children compared to controls.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Pharmacology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
- Dexamethasone is used to treat BPD but its long-term cardiac effects are unknown.
- Previous studies suggest potential cardiac remodeling after neonatal dexamethasone exposure.
Purpose of the Study:
- To investigate long-term cardiac diastolic function in children treated with dexamethasone for BPD.
- To assess if early dexamethasone exposure impacts myocardial relaxation in childhood.
- To evaluate systolic and diastolic cardiac parameters in a cohort of children with a history of BPD and dexamethasone treatment.
Main Methods:
- Comparative echocardiographic study of children (3-8 years) treated with dexamethasone for BPD versus matched controls.
- Assessment of key diastolic function parameters including isovolumic relaxation time (τ), peak E and A velocities, and E:A ratios.
- Evaluation of systolic function parameters and left ventricular mass.
Main Results:
- No significant differences in diastolic function parameters (τ, E:A ratio, peak E and A velocities) between dexamethasone-treated and control groups.
- Systolic function measures (ejection fraction, velocity of circumferential fiber shortening) were comparable between groups.
- Left ventricular mass was similar, confirming resolution of hypertrophic cardiomyopathy in the dexamethasone group.
Conclusions:
- Neonatal dexamethasone treatment for BPD does not appear to cause long-term cardiac diastolic dysfunction in childhood.
- Myocardial relaxation and overall cardiac function are reassuringly normal in children with a history of BPD treated with dexamethasone.
- These findings suggest a favorable long-term cardiac safety profile for early dexamethasone use in managing BPD.
Objectives:
To determine if dexamethasone given to premature infants with bronchopulmonary dysplasia would result in cardiac diastolic dysfunction in early childhood, a topic unstudied in humans.
Study Design:
We compared seven children ages 3 to 8 years born at 26 weeks' gestation and given dexamethasone for bronchopulmonary dysplasia with eight gestation-matched and age-matched control children using echocardiography to assess measures of systolic and diastolic function. All dexamethasone patients had resolved hypertrophic cardiomyopathy.
Results:
Dexamethasone patients had the same normal τ and isovolumic relaxation time (24.9 ± 2.8 and 54.6 ± 6.3 ms) as control patients (22.1 ± 3.0 and 48.8 ± 6.7 ms). Peak A velocities were the same in dexamethasone patients as in control patients (59.5 ± 15 versus 49.4 ± 5.8 cm/s, P = .10), resulting in unchanged E:A ratios (1.89 ± 0.57 versus 2.15 ± 0.43, P = .22). Peak E velocity and E-wave deceleration times were not different. We found no significant differences in measures of systolic function (heart rate-corrected velocity of circumferential fiber shortening, wall stress, and ejection fraction). Left ventricular mass was the same between the groups confirming resolution of hypertrophic cardiomyopathy.
Conclusions:
These data are consistent with normal myocardial relaxation, suggesting that long-term diastolic function is reassuringly normal in children who received dexamethasone as premature infants with resolution of hypertrophic cardiomyopathy.
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