Effect of systemic hydrocortisone in ventilated preterm infants on parent-reported behavioural outcomes at 2 years’ corrected age: follow-up of a randomised clinical trial

Abstract

ObjectiveTo report the parent-reported behavioural outcomes of infants included in the Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants study at 2 years’ corrected age (CA).DesignRandomised placebo-controlled trial.SettingDutch and Belgian neonatal intensive care units.PatientsInfants born <30 weeks’ gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life.InterventionInfants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).Main outcome measuresParent-reported behavioural outcomes at 2 years’ CA assessed with the Child Behavior Checklist (CBCL 1½−5).ResultsParents completed the CBCL of 183 (70% (183/262)) infants (hydrocortisone group, n=96; placebo group, n=87). Multiple imputation was used to account for missing data. Infants with critically elevated T-scores (>55) were found in 22.9%, 19.1% and 29.4% of infants for total, internalising and externalising problems, respectively; these scores were not significantly different between groups (mean difference −1.52 (95% CI −4.00 to 0.96), −2.40 (95% CI −4.99 to 0.20) and −0.81 (95% CI −3.40 to 1.77), respectively). In the subscales, we found a significantly lower T-score for anxiety problems in the hydrocortisone group (mean difference −1.26, 95% CI −2.41 to –0.12).ConclusionThis study found high rates of behaviour problems at 2 years’ CA following very preterm birth, but these problems were not associated with hydrocortisone treatment initiated between 7 and 14 days after birth in ventilated preterm infants.Trial registration numberNTR2768; EudraCT 2010-023777-19.

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

“…235 Clinicians may be more willing to use hydrocortisone before 21 days of life as unlike dexamethasone, early postnatal hydrocortisone use has not been linked to neurodevelopmental impairment. 107,236,237 No evidence of adverse outcomes has been noted in the follow-up of participants in the SToP BPD Trial, who received later, higher doses of hydrocortisone; 237 however, there is as yet no evidence from RCTs that treatment with hydrocortisone beyond the first week of life is helpful in reducing BPD even for higher risk populations. [238][239][240] In summary, treatment with systemic steroids with the goal of reducing risk for BPD should be strongly considered in preterm infants who remain IMV dependent at or approaching 21 days of life.…”