{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T06:07:57Z","timestamp":1773468477820,"version":"3.50.1"},"reference-count":162,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014468","name":"Mallinckrodt Pharmaceuticals","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014468","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Fonds de recherche du Qu\u00e9bec\u2014Sant\u00e9"},{"name":"ATS Early Career Investigator Award"},{"DOI":"10.13039\/501100000024","name":"CIHR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100020867","name":"Montreal Children\u2019s Hospital Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100020867","id-type":"DOI","asserted-by":"crossref"}]},{"name":"McGill University Department of Pediatrics"},{"name":"Pediatric Research Foundation"},{"name":"Department of Pediatrics of McGill University"},{"name":"Just for Kids Foundation"},{"name":"Brain-Heart Interconnectome"},{"name":"McGill University and the Research Institute of the McGill University Health Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Postnatal corticosteroids are frequently administered to extremely preterm infants to support respiratory management, yet their effects on the immature cardiovascular system are complex and underexplored. As the second installment in a series on physiology-informed steroid use, this narrative review focuses on the cardiovascular consequences of systemic corticosteroid therapy in preterm neonates. We examine how corticosteroids influence key aspects of cardiovascular physiology, including ductal closure, systemic and pulmonary vascular resistance, myocardial remodeling, and autonomic regulation. Attention is given to the hemodynamic transition of early postnatal life and how steroid exposure may interact with patency of the ductus arteriosus and vascular development. The potential for corticosteroids to contribute to reactive myocardial hypertrophy, systemic hypertension, and pulmonary hypertension is also reviewed in the context of both short- and long-term outcomes. Emerging diagnostic and monitoring tools are discussed for their potential to guide individualized therapy. These include targeted neonatal echocardiography (TnECHO) to assess cardiac function and structure, electrocardiography (ECG) for rhythm and conduction abnormalities, heart rate variability analysis for autonomic function, and circulating biomarkers to evaluate myocardial stress and inflammation. Together, these tools may inform tailored steroid timing and dosing, especially in the research context, while monitoring for signs of cardiovascular side effects in real time. By synthesizing mechanistic insights with evolving clinical evidence, this review highlights the need for a more nuanced understanding of how corticosteroids affect the developing cardiovascular system. It underscores the importance of integrating cardiovascular monitoring into routine care to optimize therapeutic benefit while minimizing unintended harm. Alongside companion reviews addressing respiratory and growth impacts, this installment contributes to a broader framework for individualized, physiology-driven steroid use in extremely preterm infants.<\/jats:p>","DOI":"10.3390\/children13030395","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:12:24Z","timestamp":1773321144000},"page":"395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postnatal Steroids in Preterm Infants: A Narrative Review Series\u2014Part 2: Cardiovascular Impacts"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4912-7462","authenticated-orcid":false,"given":"Phoenix","family":"Plessas-Azurduy","sequence":"first","affiliation":[{"name":"Division of Clinical & Translational Research, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 0G4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anie","family":"Lapointe","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Universit\u00e9 de Montr\u00e9al, CHU Sainte-Justine, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2990-5412","authenticated-orcid":false,"given":"Punnanee","family":"Wutthigate","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Sp\u00e9nard","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9anne","family":"Villeneuve","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Universit\u00e9 de Montr\u00e9al, CHU Sainte-Justine, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5412-9526","authenticated-orcid":false,"given":"Audrey","family":"H\u00e9bert","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, CHU de Qu\u00e9bec, Laval University, Qu\u00e9bec, QC G1V 0A6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4142-3707","authenticated-orcid":false,"given":"Eilon","family":"Shany","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Saban Children\u2019s Hospital, Soroka Medical Center, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Saban Children\u2019s Hospital, Soroka Medical Center, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1027-9418","authenticated-orcid":false,"given":"Neta","family":"Geva","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Saban Children\u2019s Hospital, Soroka Medical Center, Beer Sheva 84101, Israel"},{"name":"Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wadi","family":"Mawad","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiscar","family":"Cavall\u00e9-Garrido","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Beltempo","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wissam","family":"Shalish","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-3654","authenticated-orcid":false,"given":"Guilherme","family":"Sant\u2019Anna","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-0964","authenticated-orcid":false,"given":"Gabriel","family":"Altit","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Montreal Children\u2019s Hospital, Montreal, QC H4A 3H9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e206826","DOI":"10.1001\/jamapediatrics.2020.6826","article-title":"Assessment of Postnatal Corticosteroids for the 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