Reversible Steroid-Induced Hypertrophic Cardiomyopathy with Left Ventricular Outflow Tract Obstruction in Two Newborns

Haney, Isabel; Lachance, Christian; Doesburg, Nicolaas H. van; Fouron, Jean‐Claude

doi:10.1055/s-2007-994472

Cited by 14 publications

(7 citation statements)

References 4 publications

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“…This is to be taken into account when evaluating left heart dimensions in preterm babies, especially when treatments known to cause left ventricle hypertrophy are administered. In fact, one of the most frequent applications of echocardiography in the neonatal intensive care units is checking during steroid treatment, which can produce a marked thickening of the septum and of the posterior wall [3,7,16,20], sometimes followed by a severe hypertrophic myocardiopathy with symptomatic left ventricle outow tract obstruction [5,8]. We tried to establish normal values in these infants using a long-axis M-mode because this is a routine technique in daily clinical practice [4,7,15].…”

Section: Discussionmentioning

confidence: 99%

Left ventricle dimensions in preterm infants during the first month of life

Zecca

Romagnoli

Vento

et al. 2001

European Journal of Pediatrics

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This study was designed to evaluate left ventricle dimensions in preterm infants during the first month of life, in order to define reference values and their correlation with gestational age, birth weight, gender and baseline. Thirty-five infants, gestational age 25-29 (mean 27.9 +/- 1.4) weeks, birth weight 750-1249 (mean 965 +/- 206) g, were measured using echocardiography on days 3, 7, 14, 21 and 28 of life. The following dimensions were measured: end-systolic and end-diastolic interventricular septum thickness, end-systolic and end-diastolic left ventricle posterior wall thickness, end-diastolic and end-systolic left ventricle diameter. A progressive and significant increase of all the left ventricle measurements was observed during the first month of life. Left ventricle dimensions at the first scan (Day 3) correlated with birth weight but not with gestational age and gender. The degree of the increase observed during the first month of life was inversely related to the baseline, suggesting that the smaller the left ventricle is at birth, the higher is its postnatal increase toward dimensions similar to those of term infants. Our study gives reference data about left ventricle dimensions of preterm infants during the first month of life and is helpful when making a diagnosis of left ventricular hypertrophy in these subjects.

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Section: Discussionmentioning

confidence: 99%

Left ventricle dimensions in preterm infants during the first month of life

Zecca

Romagnoli

Vento

et al. 2001

European Journal of Pediatrics

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“…1 Treatment with intravenous dexamethasone has been shown to shorten the duration of mechanical ventilation in premature infants, 2 and to improve pulmonary function. 3 However, dexamethasone therapy has many potential side effects in premature infants, including hyperglycemia, 4 hypertension, 5 cardiomyopathy, 6 adrenal suppression, [7][8][9] and gastrointestinal bleeding. 10 Dexamethasone has been shown to cause neutrophilia and eosinopenia 11,12 in addition to inhibition of colony formation of the hematopoietic progenitor cells in in vitro experiments.…”

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confidence: 99%

Effect of Dexamethasone on Lymphocyte Subpopulations in Premature Infants with Bronchopulmonary Dysplasia

et al. 1999

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OBJECTIVE:This study was designed to determine the effect of dexamethasone treatment on peripheral blood lymphocyte counts and subpopulations in premature infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN:Peripheral blood lymphocyte subpopulations in 12 premature infants with BPD were analyzed before treatment with a 6-week course of dexamethasone (day 0), on days 3 and 10 of treatment, and 2 weeks after discontinuing dexamethasone therapy (day 56). Lymphocyte immunophenotypes were determined using direct two-color immunofluorescent staining followed by flow cytometry. RESULTS:The percentage of lymphocytes was significantly lower on days 3 (17.55 Ϯ 2.55) and 10 (20 Ϯ 11.8) of dexamethasone therapy compared with before (30.36 Ϯ 6.41) or after treatment. The percentage of T cells was significantly lower on days 3 and 10 of dexamethasone therapy (mean Ϯ SEM; 58.09 Ϯ 1.93 and 60.09 Ϯ 2.47, respectively) compared with before (67.09 Ϯ 4.24) or after treatment. The absolute number of T cells was significantly lower on day 10 of therapy. The percentage of CD4 ϩ cells was significantly lower on days 3 (38.91 Ϯ 2.49) and 10 (40.45 Ϯ 2.24) of therapy, and this decrease persisted after dexamethasone was stopped (36.73 Ϯ 3.41). The absolute number of CD4 cells was significantly lower on day 10 (1328 Ϯ 216) of therapy and reached a nadir on day 56 (1143 Ϯ 106). Similarly, the CD4/CD8 ratio was also significantly lower on days 3 and 10 of treatment (1.56 Ϯ 0.18 and 1.64 Ϯ 0.14, respectively) and reached a nadir on day 56 (1.04 Ϯ 0.13). CONCLUSION:Dexamethasone significantly reduced the percentage and absolute number of lymphocytes, T cells, and CD4 cells, as well as the CD4/CD8 ratio. A reduction in CD4 cells and in the CD4/CD8 ratio persisted 2 weeks after dexamethasone therapy was stopped. In contrast, the absolute number of B cells increased transiently, and CD8 cells were unaffected by dexamethasone. This alteration in lymphocyte subpopulations may help account for the clinically beneficial anti-inflammatory effect of dexamethasone in the treatment of BPD complicated by respiratory failure. The dexamethasone-induced decrease in CD4 cells may also increase the susceptibility of these infants to infection.Bronchopulmonary dysplasia (BPD) is a chronic lung disease associated with mechanical ventilation in premature infants and a common cause of morbidity in the neonatal intensive care unit. The incidence of BPD is Յ40% among infants with respiratory distress syndrome who require mechanical ventilation. 1 Treatment with intravenous dexamethasone has been shown to shorten the duration of mechanical ventilation in premature infants, 2 and to improve pulmonary function. 3 However, dexamethasone therapy has many potential side effects in premature infants, including hyperglycemia, 4 hypertension, 5 cardiomyopathy, 6 adrenal suppression, 7-9 and gastrointestinal bleeding. 10 Dexamethasone has been shown to cause neutrophilia and eosinopenia 11,12 in addition to inhibition of colony formation of the hematopoietic progenito...

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“…Of these, 245 (85%) were still on some form of respiratory support at 36 weeks (Chow et al, 2021). Meta-analyses have previously shown postnatal steroids to be effective in preventing 'severe' BPD, although most of the analysed studies used much higher cumulative Dex dosages (2-7 mg kg -1 per treatment cycle, compared to 0.89 mg kg -1 used in the present study) (Halliday et al, 2009;Haney et al, 1995;Skelton et al, 1998;Zecca et al, 2001).…”

Section: Improvements In Respiratory Support Parametersmentioning

confidence: 77%