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Hypertrophic cardiomyopathy associated with dexamethasone therapy for chronic lung disease in preterm infants
B A Israel1, F S Sherman, R D Guthrie
1Division of Neonatology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Long-term dexamethasone therapy for chronic lung disease (CLD) in infants may cause hypertrophic cardiomyopathy. This cardiac condition was observed in 57% of infants receiving prolonged treatment, with some cases contributing to mortality.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Chronic lung disease (CLD) is a common complication in preterm infants.
- Dexamethasone is frequently used to manage CLD, but its long-term cardiac effects are not fully understood.
Purpose of the Study:
- To investigate potential deleterious cardiac structural effects of long-term dexamethasone therapy in infants with CLD.
- To assess the association between dexamethasone exposure duration and cardiac abnormalities.
Main Methods:
- Retrospective review of preterm infants with CLD born between October 1989 and October 1990.
- Infants were grouped based on dexamethasone exposure duration: none, <8 days, and ≥26 days (including 42-day courses).
- Serial echocardiographic data were analyzed for cardiac structural changes, particularly left ventricular hypertrophy.
Main Results:
- Left ventricular hypertrophy was observed in 8 of 14 (57%) infants receiving prolonged dexamethasone therapy (≥26 days).
- Hypertrophy typically appeared near the end of the treatment course.
- Of the eight affected infants, five died, with hypertrophic cardiomyopathy contributing to mortality in three.
Conclusions:
- Prolonged dexamethasone treatment for CLD in preterm infants is associated with a significant incidence of hypertrophic cardiomyopathy.
- Regression of hypertrophy was noted in surviving infants after dexamethasone cessation.
- Further research is warranted to elucidate the mechanisms and long-term implications.
Abstract:
To assess whether long-term dexamethasone therapy for chronic lung disease (CLD) in infancy is associated with any deleterious cardiac structural effects, we conducted a retrospective review of all preterm infants with CLD born between October 1, 1989, and October 1, 1990, who had serial echocardiographic data available. These infants were divided into three groups based on the length of their exposure to dexamethasone. Group 1 contained nine infants with CLD who did not receive dexamethasone. Group 2 was comprised of six infants who received dexamethasone for less than 8 days. Group 3 contained one infant who received a 26-day course, and 13 infants who received at least one 42-day course of dexamethasone for CLD. Left ventricular hypertrophy was noted in 8 of 14 (57%) infants in group 3; hypertrophy usually was noted near the end of the treatment course. Five of these eight affected infants died; the hypertrophic cardiomyopathy was considered to have contributed to mortality in three of these five infants. Regression of the hypertrophy was noted in the three surviving infants in group 3 after the dexamethasone course was completed. We speculate that prolonged dexamethasone treatment for CLD is associated with hypertrophic cardiomyopathy in a significant portion of preterm infants.