Early low-dose hydrocortisone: is the neurodevelopment affected?

Abstract

Type of investigation Prognosis; exploratory secondary analysis of an interventional randomized controlled trial. Question In extremely preterm infant (<28 weeks), is early low-dose hydrocortisone compared to placebo associated with neurodevelopmental impairment at 2 years of age? Methods Patients Surviving infants enrolled in the PREMILOC trial conducted in France between 2008 and 2014. Intervention Double-blind, multicenter, randomized, placebo-controlled trial of infants born between 24 0/7 weeks and 27 6/7 weeks of gestation and before 24 h of postnatal age, assigned to receive either placebo or low-dose hydrocortisone (0.5 mg/kg twice per day for 7 days, followed by 0.5 mg/kg per day for 3 days). Main results For the pre-specified exploratory outcome, the distribution of patients without neurodevelopmental impairment (73% in the hydrocortisone group vs. 70% in the placebo group), with mild neurodevelopmental impairment (20% in the hydrocortisone group vs. 18% in the placebo group), or with moderate to severe neurodevelopmental impairment (7% in the hydrocortisone group vs. 11% in the placebo group) was not found to be statistically significantly different between the two groups (p = 0.33). Qualitative assessment of patients using standardized neurological examination also was not statistically significantly different between groups (p = 0.87). Study conclusion In this follow-up study of premature infants who were randomly assigned at birth to receive low-dose hydrocortisone or placebo for 10 days, hydrocortisone treatment was not associated with any adverse effects on neurodevelopmental outcome at 22 months of corrected age.

New Pharmacologic Approaches to Bronchopulmonary Dysplasia

“…Follow-up studies revealed no increase in long-term adverse neurodevelopmental outcomes. 39 , 40 Given the known risks and only potential benefits of postnatal steroids, the decision to administer steroids, as well as the optimal dosage and timing, remains challenging and unclear. Identifying biomarkers or genes that confer a greater likelihood of improved respiratory status with postnatal steroid administration would be a worthwhile contribution.…”