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Objective: To determine if exposure to more than one course of antenatal gluco cortlcoids is associated with changes in infant blood pressure and myocardial wa ll thickness in the first month after birth. Design: Prospective cohort study. S etting: Tertiary neonatal intensive care unit. Participants: Mothers who were el igible for but declined to enter a randomised trial of repeated doses of antenat al glucocorticoids (ACTORDS)-that is, who had a singleton, twin, or triplet pre gnancy at < 32 weeks gestation, had received an initial course of glucocorticoid s seven or more days previously, and were considered to be at continued risk of preterm birth. Main outcome measures: Blood pressure daily for the first week th en weekly until 4 weeks of age. End diastolic interventricular septal and left v entricular posterior wall (EDIVS and EDLVPW) thickness at 48-72 hours after bir th. Results: Thirty seven women were enrolled and delivered 50 infants. Thirty m others (39 infants) were exposed to one course of glucocorticoids, and seven mot hers (11 infants) to more than one course. Blood pressures were higher in the fi rst week after birth in infants exposed to multiple courses of glucocorticoids, and in infants with a latency between last exposure and delivery of less than se ven days. Systolic blood pressure on day 1 was > 2SD above published normal rang es in 67%of babies exposed to multiple courses and 24%of babies exposed to a s ingle course of glucocorticoids (p = 0.04). There was no difference between grou ps in thickness of the EDIVS or EDLVPW. However, 44/50 (88%) babies had EDIVS a nd 49/50 (98%) babies had EDLVPW thickness > 2 SD above the expected mean for b irth weight and gestation. EDIVS but not EDLVPW thickness increased with increas ing latency (mean 0.02 mm/day, P=0.03). Conclusion: Future randomised trials sho uld assess the long term effects of exposure to antenatal glucocorticoids, particularly multiple courses, on the cardiovascular status of the infant.
Objective: To determine if exposure to more than one course of antenatal gluco cortlcoids is associated with changes in infant blood pressure and myocardial wa ll thickness in the first month after birth. Design: Prospective cohort study. S etting: Tertiary neonatal intensive care unit. Participants: Mothers who were eligible for but declined to enter a randomized trial of repeated doses of antenat al glucocorticoids (ACTORDS) -that is, who had a singleton, twin, or triplet pre gnancy at <32 weeks gestation, had received an initial course of glucocorticoid s seven or more days previously, and were considered to be at continued risk of preterm birth. Main outcome measures: Blood pressure daily for the first week th week weekly until 4 weeks of age. End diastolic interventricular septal and left v entricular posterior wall (EDIVS and EDLVPW) thickness at 48-72 hours after bir th. Results: Thirty seven women were enrolled and delivered 50 infants. Thirty m others (39 infants) were exposed to one course of glucocorticoids, and seven mothers (11 infants) to more than one course. Blood pressures were higher in the fi rst week after birth in infants exposed to multiple courses of glucocorticoids, and in infants with a latency between last exposure and Systolic blood pressure on day 1 was> 2SD above published normal rang es in 67% of babies exposed to multiple courses and 24% of babies exposed to asingle course of glucocorticoids (p = 0.04). There was no difference between grou ps in thickness of the EDIVS or EDLVPW. However, 44/50 (88%) babies had EDIVS a nd 49/50 (98%) babies had EDLVPW thickness> 2 SD above the expected mean for b irth weight (random: 0.02 mm / day, P = 0.03). Conclusion: Future randomized trials sho uld assess the long term effects of exposure to antenatal glucocorticoids, particularly multiple multiple courses, on the cardiovascular status of the infanhe.