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Postnatal glucocorticoid use impacts renal function in VLBW neonates

Christiane Mhanna1, Merlin Pinto2, Hannah Koechley2

  • 1Department of Pediatrics, The Cleveland Clinic Children's Hospital, Cleveland, OH, USA.

Pediatric Research
|August 17, 2021
PubMed

Insights

High-dose glucocorticoids in preterm infants are linked to increased blood pressure and altered renal function. Prudent use is recommended to mitigate long-term cardiovascular and kidney risks in VLBW infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pharmacology
  • Clinical Pediatrics

Background:

  • Preterm neonates often require glucocorticoids for managing hypotension and bronchopulmonary dysplasia.
  • Investigated the impact of cumulative glucocorticoid dose and duration on blood pressure and renal function in very low birthweight (VLBW) infants.

Purpose of the Study:

  • To evaluate the association between postnatal glucocorticoid therapy and blood pressure and renal function in VLBW infants.
  • To determine the effect of cumulative dose and duration of glucocorticoid exposure on these outcomes.

Main Methods:

  • Retrospective cohort study of infants with gestational age ≤35 weeks born between 2015 and 2019.
  • Extracted data on demographics, clinical characteristics, steroid dose/duration, blood pressure, and creatinine at NICU discharge.
  • Analyzed associations between steroid exposure and cardiovascular/renal parameters.

Main Results:

  • Infants receiving postnatal steroids had higher rates of hypertension (28% vs. 16%).
  • A correlation was found between cumulative steroid dosage and systolic blood pressure.
  • Increased steroid dose and duration were associated with higher creatinine clearance at discharge.

Conclusions:

  • Cumulative dose and duration of postnatal steroids are linked to elevated systolic blood pressure in preterm infants.
  • Prudent use of postnatal steroids is crucial to prevent long-term cardiovascular and renal morbidity.
  • Glucocorticoid use may improve creatinine clearance but could increase the risk of chronic kidney disease.
Abstract

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