Pediatr Cardiol 22:363–364, 2001
DOI: 10.1007/s002460010249
Pediatric
Cardiology
© Springer-Verlag New York Inc. 2001
Letter to the Editor
Irreversible Cardiac Changes After Dexamethasone Treatment for
Bronchopulmonary Dysplasia
Dexamethasone continues to be used in the treatment of
severe bronchopulmonary dysplasia [5]. Dexametha-
sone-related cardiac side effects, which include septal
hypertrophy and left ventricular outflow tract obstruc-
tion, are usually reversible [1, 2, 4, 8]. We report a case
of severe dexamethasone-induced cardiomyopathy with
an ultimately fatal outcome.
M.E.S. was delivered by cesarean section due to
premature labor at a gestational age of 25 weeks with a
birth weight of 975 g. After initial severe respiratory
distress syndrome the patient developed massive BPD.
Because of failure to wean from mechanical ventilation
under conventional therapy, a total of five courses of
dexamethasone (DXM) were given. The standard dosage
regimen was 0.5 mg/kg/day tapered over 10 days with
modification according to the clinical course. DXM re-
peatedly facilitated weaning and allowed several periods
without mechanical ventilation.
Initially, increases in intraventricular septum (IVS)
diameter were within the normal range [7] and com-
pletely reversible. Severe septal hypertrophy up to 12
mm developed during the fourth course of DXM and
regressed almost to normal with dose reduction and con-
comitant administration of a calcium antagonist. An un-
usually rapid and irreversible increase in IVS thickness
was observed following a total of 0.6 mg/kg of DXM
given over 4 days (Fig. 1).
At about 5 months of age the child developed pneu-
monia. On day 145 of life he died from sudden cardiac
arrest refractory to resuscitation procedures.
Postmortem microscopic examination revealed areas
with enormous hypertrophy of septal cardiomyocytes
and formation of giant nuclei next to normal myo-
cardium. Furthermore, diffuse fibrosis as well as cir-
cumscribed areas with massive fibrotic changes were
found.
Our case provides further evidence that dexametha-
sone should only be used restrictively because its ben-
eficial effects on neonatal chronic lung disease may be
compromised by serious and sometimes fatal side ef-
fects. A lower initial dose [2, 6] and short-term courses
[3, 6] may help to reduce complications while still being
effective. Repeated use of dexamethasone should also be
viewed critically because there might be a sensitizing
effect on the immature myocardium leading to an in-
creased and accelerated development of septal hypertro-
phy (Fig. 1).
F.-T. Riede, M.D.
Department of Pediatrics
Friedrich-Schiller-University of Jena
Kochstraße 2
07740 Jena, Germany
Fig. 1. Relation between dexamethasone (DXM)
therapy and interventricular septum (IVS) diameter
over time. Also represented are the normal range for
IVS diameter corrected for body weight, duration of
calcium antagonist administration, and mechanical
ventilation. Ca antagonist, calcium antagonist; mv,
mechanical ventilation (bottom line, period of me-
chanical ventilation; top line, no mechanical ventila-
tion).
Bondi
