Abstract
Background
Preterm neonates often require glucocorticoids to manage refractory hypotension, prevent, and treat bronchopulmonary dysplasia. We have investigated the effect of cumulative dose and duration of glucocorticoids on blood pressure and renal function in VLBW infants.
Methods
In this retrospective cohort study, medical records of infants (GA ≤ 35 weeks) born January 2015 to December 2019 were reviewed to extract demographic and clinical characteristics, dose and duration of steroids, blood pressure (BP), and creatinine at the time of discharge from the neonatal intensive care unit.
Results
Two hundred and eighty-three neonates with average GA (28 ± 3 weeks) and birthweight (1060±381 g). Twenty-eight percent (33/116) of infants who received postnatal steroids developed hypertension versus 16% (27/167) of controls (OR = 2.0, p = 0.011). There was a correlation between the cumulative dosage of postnatal steroids and systolic BP (R2 = 0.06, p < 0.001). With increasing steroid dose and total steroid days, there was a significant increase in creatinine clearance at the time of discharge (R2 = 0.13, p < 0.001; R2 = 0.13, p < 0.001, respectively).
Conclusions
Cumulative dose of postnatal steroids and duration of use is associated with increased systolic BP in premature infants. Postnatal steroids should be used prudently to prevent long-term cardiovascular and renal morbidity.
Impact
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Preterm neonates are exposed to a high dose of glucocorticoids during their neonatal intensive care stay.
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The dose and duration of use of postnatal glucocorticoids was associated with significant increase in blood pressure at the time of discharge in preterm neonates.
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Postnatal glucocorticoid use is associated with improved creatinine clearance likely due to a state of hyperfiltration and may lead to chronic kidney disease later in life.
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Postnatal glucocorticoids should be used prudently in this highly vulnerable population
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Acknowledgements
This study was internally funded by Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
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C.M. and H.K. were responsible for conducting study, data collection, data analysis and writing initial draft of manuscript. M.P., N.K., R.R., P.P., and C.M. were responsible for data analysis and preparing tables and figures and helped write the initial draft of the manuscript. P.S. was responsible for study design, data analysis, data interpretation and wrote the final version of the manuscript. All authors approved the final revised version of submitted manuscript.
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This retrospective chart review study involving human subjects was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Review Committee (IRB) of MetroHealth Medical Center approved this study # IRB19-00229.
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This was a retrospective study and IRB granted waiver of consent from subjects.
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Mhanna, C., Pinto, M., Koechley, H. et al. Postnatal glucocorticoid use impacts renal function in VLBW neonates. Pediatr Res 91, 1821–1826 (2022). https://doi.org/10.1038/s41390-021-01624-1
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DOI: https://doi.org/10.1038/s41390-021-01624-1
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