Preterm Neonate With Dexamethasone-Induced Acute Hypertrophic Cardiomyopathy and Cardiogenic Shock

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Pharmacology

Background:

• Steroid-induced cardiomyopathy is a known complication in preterm neonates.
• Adverse effects of steroids are typically insidious and transient.
• Limited data exists on acute cardiac decompensation from small-dose steroid use.

Purpose of the Study:

• To report the first case of acute hypertrophic cardiomyopathy and cardiogenic shock following small-dose dexamethasone administration in an extremely low birth weight infant.
• To raise awareness of potential adverse cardiovascular effects of dexamethasone in neonates, even at low doses.

Main Methods:

• Case report of an extremely low birth weight infant (26-week gestational age).
• Administration of small-dose dexamethasone for respiratory support.
• Monitoring for cardiac function and adverse events.
• Review of existing literature on steroid-induced cardiomyopathy.

Main Results:

• The infant developed hypertrophic cardiomyopathy and cardiogenic shock within hours of dexamethasone administration.
• Cardiac function improved after drug discontinuation and inotropic support.
• Ejection fraction was significantly reduced following dexamethasone exposure.

Conclusions:

• Small-dose dexamethasone can precipitate acute cardiac decompensation, including hypertrophic cardiomyopathy and cardiogenic shock, in extremely low birth weight infants.
• This case underscores the importance of vigilant cardiac monitoring in neonates receiving steroids.
• Clinical practice should consider potential acute cardiovascular risks even with recommended low steroid doses.