Karemaker Rosa, Karemaker John M, Kavelaars Annemieke, Tersteeg-Kamperman Marijke, Baerts Wim, Veen Sylvia, Samsom Jannie F, van Bel Frank, Heijnen Cobi J
Department of Neonatology, Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, Netherlands.
Pediatrics. 2008 Nov;122(5):978-87. doi: 10.1542/peds.2007-3409.
The goal was to investigate cardiovascular responses to a psychosocial stressor in school-aged, formerly premature boys and girls who had been treated neonatally with dexamethasone or hydrocortisone because of chronic lung disease.
We compared corticosteroid-treated, formerly preterm infants with formerly preterm infants who had not been treated neonatally with corticosteroids (reference group). Children performed the Trier Social Stress Test for Children, which includes a public speaking task and a mental arithmetic task. Blood pressure was recorded continuously before, during, and after the stress test. Plasma norepinephrine levels were determined before the test, directly after the stress task, and after recovery.
Overall, in response to stress, girls had significantly larger changes in systolic blood pressure and mean arterial pressure and in stroke volume and cardiac output, compared with boys. Boys exhibited larger total peripheral resistance responses, compared with girls. The hydrocortisone group did not differ significantly from the reference group in any of the outcome measures. However, dexamethasone-treated children had smaller stress-induced increases in systolic and mean arterial blood pressure than did hydrocortisone-treated children. In addition, the dexamethasone group showed smaller increases in stroke volume and blunted norepinephrine responses to stress, compared with children in the reference group. Correction for gender did not affect these results.
The differences in cardiovascular stress responses between girls and boys are consistent with known gender differences in adult cardiovascular stress responses. Our data demonstrate that neonatal treatment with dexamethasone has long-term consequences for the cardiovascular and noradrenergic stress responses; at school age, the cardiovascular stress response was blunted in dexamethasone-treated children. Hydrocortisone-treated children did not differ from the reference group, which suggests that hydrocortisone might be a safe alternative to dexamethasone for treating chronic lung disease of prematurity.
本研究旨在调查学龄期曾患早产的男孩和女孩，因慢性肺病在新生儿期接受地塞米松或氢化可的松治疗后，其心血管系统对心理社会应激源的反应。
我们将接受皮质类固醇治疗的曾患早产儿与未在新生儿期接受皮质类固醇治疗的曾患早产儿（参照组）进行比较。儿童进行儿童版的特里尔社会应激测试，其中包括公开演讲任务和心算任务。在应激测试前、测试期间和测试后持续记录血压。在测试前、应激任务结束后即刻以及恢复后测定血浆去甲肾上腺素水平。
总体而言，在应激反应中，与男孩相比，女孩的收缩压、平均动脉压、每搏输出量和心输出量的变化显著更大。与女孩相比，男孩的总外周阻力反应更大。氢化可的松组在任何一项结果指标上与参照组均无显著差异。然而，与接受氢化可的松治疗的儿童相比，接受地塞米松治疗的儿童应激诱导的收缩压和平均动脉血压升高幅度较小。此外，与参照组儿童相比，地塞米松组的每搏输出量增加幅度较小，且去甲肾上腺素对应激的反应减弱。校正性别后不影响这些结果。
男孩和女孩在心血管应激反应方面的差异与成人已知的心血管应激反应性别差异一致。我们的数据表明，新生儿期接受地塞米松治疗对心血管和去甲肾上腺素能应激反应有长期影响；在学龄期，接受地塞米松治疗的儿童心血管应激反应减弱。接受氢化可的松治疗的儿童与参照组无差异，这表明氢化可的松可能是治疗早产儿慢性肺病的地塞米松的安全替代药物。
