دورية أكاديمية
Vascular responsiveness to low-dose dexamethasone in extremely premature infants: negative influence of fetal growth restriction.
| العنوان: | Vascular responsiveness to low-dose dexamethasone in extremely premature infants: negative influence of fetal growth restriction. |
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| المؤلفون: | Sehgal A; Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.; Department of Pediatrics, Monash University, Melbourne, Victoria, Australia., Nold MF; Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.; Department of Pediatrics, Monash University, Melbourne, Victoria, Australia.; Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia., Roberts CT; Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.; Department of Pediatrics, Monash University, Melbourne, Victoria, Australia., Menahem S; Department of Pediatrics, Monash University, Melbourne, Victoria, Australia.; Paediatric and Fetal Cardiac Units, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia. |
| المصدر: | American journal of physiology. Heart and circulatory physiology [Am J Physiol Heart Circ Physiol] 2024 Sep 01; Vol. 327 (3), pp. H666-H671. Date of Electronic Publication: 2024 Jul 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Physiological Society Country of Publication: United States NLM ID: 100901228 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-1539 (Electronic) Linking ISSN: 03636135 NLM ISO Abbreviation: Am J Physiol Heart Circ Physiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Bethesda, Md. : American Physiological Society, |
| مواضيع طبية MeSH: | Dexamethasone*/administration & dosage , Fetal Growth Retardation*/physiopathology , Fetal Growth Retardation*/drug therapy , Infant, Extremely Premature* , Vascular Resistance*/drug effects, Humans ; Infant, Newborn ; Female ; Male ; Prospective Studies ; Gestational Age ; Ventricular Function, Right/drug effects ; Glucocorticoids/administration & dosage ; Treatment Outcome ; Birth Weight |
| مستخلص: | Dexamethasone is frequently prescribed for preterm infants to wean from respiratory support and/or to facilitate extubation. This pre-/postintervention prospective study ascertained the impact on clinical (respiratory support) and echocardiographic parameters after dexamethasone therapy in preterm fetal growth restriction (FGR) infants compared with appropriate for gestational age (AGA) infants. Echocardiography was performed within 24 h before the start and after completion of 10-day therapy. Parameters assessed included those reflecting pulmonary vascular resistance and right ventricular output. Seventeen FGR infants (birth gestation and birth weight, 25.2 ± 1.1 wk and 497 ± 92 g, respectively) were compared with 22 AGA infants (gestation and birth weight, 24.5 ± 0.8 and 663 ± 100 g, respectively). Baseline respiratory severity score (mean airway pressure × fractional inspired oxygen) was comparable between the groups, (median [interquartile range] FGR, 10 [6, 13] vs. AGA, 8 ± 2.8, P = 0.08). Pre-dexamethasone parameters of pulmonary vascular resistance (FGR, 0.19 ± 0.03 vs. AGA, 0.2 ± 0.03, P = 0.16) and right ventricular output (FGR, 171 ± 20 vs. 174 ± 17 mL/kg/min, P = 0.6) were statistically comparable. At post-dexamethasone assessments, the decrease in the respiratory severity score was significantly greater in AGA infants (median [interquartile range] FGR, 10 [6, 13] to 9 [2.6, 13.5], P = 0.009 vs. AGA, 8 ± 2.8 to 3 ± 1, P < 0.0001). Improvement in measures of pulmonary vascular resistance (ratio of time to peak velocity to right ventricular ejection time) was greater in AGA infants (FGR, 0.19 ± 0.03 to 0.2 ± 0.03, P = 0.13 vs. AGA 0.2 ± 0.03 to 0.25 ± 0.03, P < 0.0001). The improvement in right ventricular output was significantly greater in AGA infants (171 ± 20 to 190 ± 21, P = 0.014 vs. 174 ± 17 to 203 ± 22, P < 0.0001). This highlights differential cardiorespiratory responsiveness to dexamethasone in extremely preterm FGR infants, which may reflect the in utero maladaptive state. NEW & NOTEWORTHY Dexamethasone (DEX) is frequently used in preterm infants dependent on ventilator support. Differences in vascular structure and function that may have developed prenatally arising from the chronic intrauterine hypoxemia in FGR infants may adversely affect responsiveness. The clinical efficacy of DEX was significantly less in FGR (birth weight < 10th centile) infants, compared with appropriate for gestational age (AGA) infants. Echocardiography showed significantly less improvement in pulmonary vascular resistance in FGR, compared with AGA infants. |
| فهرسة مساهمة: | Keywords: dexamethasone; echocardiography; fetal growth restriction; pulmonary vascular resistance; steroids |
| المشرفين على المادة: | 7S5I7G3JQL (Dexamethasone) 0 (Glucocorticoids) |
| تواريخ الأحداث: | Date Created: 20240719 Date Completed: 20240903 Latest Revision: 20240903 |
| رمز التحديث: | 20240903 |
| DOI: | 10.1152/ajpheart.00375.2024 |
| PMID: | 39028285 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1522-1539 |
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| DOI: | 10.1152/ajpheart.00375.2024 |