General

Clinical Question:
Are premature infants exposed to perinatal glucocorticoids at increased risk of developing cardiovascular complications by the time they become school aged?

Bottom Line:
By the time they become school aged, premature infants exposed to perinatal steroids have similar measures of cardiovascular function to unexposed premies. Although this is generally reassuring, if there are important adverse effects on cardiovascular events, it may take longer for them to become known. (LOE = 2b)

Reference:
de Vries WB, Karemaker R, Mooy NF, et al. Cardiovascular follow-up at school age after perinatal glucocorticoid exposure in prematurely born children: perinatal glucocorticoid therapy and cardiovascular follow-up. Arch Pediatr Adolesc Med 2008;162(8):738-744.  [PMID:18678806]

Study Design:
Cohort (retrospective)

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
These researchers studied 193 premature infants born in the Netherlands between 1993 and 1997. The premies exposed perinatally to corticosteroids were compared with unexposed premies matched for gestational age and birth weight 7 years to 10 years after birth (mean age = approximately 9 years). The researchers excluded infants who had periventricular hemorrhage and major congenital anomalies. Researchers unaware of steroid exposure performed 2-dimensional echocardiograms, performed carotid ultrasound to assess intimal thickness, and measured heart rate and blood pressure. Additionally, they measured B-type natriuretic peptide (BNP) and N-terminal BNP. Because of different steroid regimens, 4 different groups emerged: control patients, betamethasone patients, hydrocortisone patients, and dexamethasone patients. The authors found no differences in any of the outcome measures. They don't, however, report any clinical outcomes. Finally, in a retrospective study like this, it is possible that a few premature infants who already had severe or fatal cardiovascular complications were missed.