Author + information
- Hanna Carr, BS∗ (, )
- Sven Cnattingius, MD, PhD,
- Fredrik Granath, PhD,
- Jonas F. Ludvigsson, MD, PhD and
- Anna-Karin Edstedt Bonamy, MD, PhD
- ↵∗Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital, 171 76 Stockholm, Sweden
We thank Dr. Bassareo and colleagues for their response, and for bringing to the discussion perinatal corticosteroid treatment and its possible effects on cardiac development as one of the factors that may be involved in the association between low gestational age at birth and later heart failure.
It is important in this context to distinguish between antenatal and postnatal treatments. Antenatal corticosteroids (ANC) administered to women at risk of imminent preterm delivery reduce both infant mortality and morbidity (1). Postnatal corticosteroids (PNC) for the treatment and prevention of severe respiratory disease in high-risk preterm infants, although in decline after being linked to detrimental neurological effects, are still widespread despite lack of evidence of a positive benefit-risk balance. However, results from PREMILOC (Early Prevention of Broncho-pulmonary Dysplasia and Neonatal Mortality in Very Preterm Infants Using Low Dose of Hydrocortisone: a Randomized Controlled Trial) on low-dose hydrocortisone to extremely preterm infants suggest that PNC may still have a place in neonatal care (2).
As Dr. Bassareo and colleagues mention, animal experiments suggest that perinatal steroid exposure may cause persisting cardiac changes, but more and longer-term studies are needed on humans—which poses methodological challenges, particularly in relation to PNC. Regarding ANC, Aye et al. (3) recently published a study of cardiac morphology and function in preterm infants and in a subgroup analysis found no significant differences related to ANC exposure. There is also some evidence on long-term safety of ANC indicating no links to increased cardiovascular risk (4).
In their excellent editorial, Leeson and Lewandowski (5) outline how the early life event of preterm birth may lower the threshold for later expression of disease. Altered myocardial development could increase vulnerability to heart failure in surviving individuals when exposed to the challenges of life: pathogens, lifestyle habits, aging, etc. In this model for understanding preterm birth as a cardiovascular risk factor, there are many potential contributing factors. We agree that PNC could be one of them. We strongly hope that cardiovascular outcomes will be included in any longer-term follow-up of the PREMILOC trial and in other future well-designed studies.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Brownfoot F.C.,
- Gagliardi D.I.,
- Bain E.,
- Middleton P.,
- Crowther C.A.
- Aye C.Y.L.,
- Lewandowski A.J.,
- Lamata P.,
- et al.
- Leeson P.,
- Lewandowski A.J.