Growth and Neurodevelopmental Outcomes After Early Low-Dose Hydrocortisone Treatment in Extremely Low Birth Weight Infants

Watterberg, Kristi L.; Shaffer, Michele L.; Mishefske, Mary J.; Leach, Corinne L.; Mammel, Mark C.; Couser, Robert J.; Abbasi, Soraya; Cole, Cynthia H.; Aucott, Susan W.; Thilo, Elizabeth H.; Rozycki, Henry J.; Lacy, Conra Backstrom

doi:10.1542/peds.2006-3158

Cited by 145 publications

(119 citation statements)

References 32 publications

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“…54,55 In a trial of postnatal hydrocortisone, chorioamnionitis was not associated with changes in the use of supplemental oxygen, bronchodilators or steroids at 18 to 22 months. 54 However, Kumar et al 55 recently reported an association between chorioamnionitis and both recurrent wheezing and physician-diagnosed asthma. This suggests that intrauterine exposure to inflammation may indeed have long-term adverse respiratory effects.…”

Section: Lungsmentioning

confidence: 99%

Chorioamnionitis: a multiorgan disease of the fetus?

et al. 2010

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The bacterial infection of chorion and amnion is a common finding in premature delivery and is referred to as chorioamnionitis. As the mother rarely shows symptoms of a systemic inflammation, the course of chorioamnionitis is frequently asymptomatic and chronic. In contrast, the fetal inflammatory response syndrome represents a separate phenomenon, including umbilical inflammation and increased serum levels of proinflammatory cytokines in the fetus. Ascending maternal infections frequently lead to systemic fetal inflammatory reaction. Clinical studies have shown that antenatal exposure to inflammation puts the extremely immature neonates at a high risk for worsening pulmonary, neurological and other organ development. Interestingly, the presence of chorioamnionitis is associated with a lower rate of neonatal mortality in extremely immature newborns. In the following review, the pathogeneses of inflammation-associated perinatal morbidity are outlined. The concept of fetal multiorganic disease during intrauterine infection is introduced and discussed.

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Section: Lungsmentioning

confidence: 99%

Chorioamnionitis: a multiorgan disease of the fetus?

et al. 2010

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“…33,68 Data thus far are reassuring about long-term outcomes in preterm infants treated with hydrocortisone. 69,70 If hydrocortisone therapy is being considered for the extremely preterm infant with refractory hypotension, a blood specimen for cortisol should be obtained before initiating therapy. Pending that result, a test dose of 1 mg kg À1 can be given.…”

Section: Preterm Infantsmentioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

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Cortisol release in the face of illness or stress is vital for survival. Relative adrenal insufficiency occurs when a patient's cortisol response is inadequate for the degree of illness or stress. Numerous studies have documented the existence of relative adrenal insufficiency in critically ill adults, and its association with increased morbidity and mortality. There is increasing evidence that relative adrenal insufficiency may be an etiology for hemodynamic instability and hypotension in the critically ill newborn, but compared with the adult population, there is still a paucity of data in this population. Randomized controlled trials are needed to evaluate the efficacy and safety of glucocorticoids for the treatment of cardiovascular insufficiency due to relative adrenal insufficiency in ill preterm and term newborn infants. Keywords: adrenocorticotropin; ACTH; adrenal insufficiency; corticotrophin-releasing hormone; cortisol; critically ill infants hypothalamic-pituitary-adrenal axis; newborns-full term Introduction Activation of the hypothalamic-pituitary-adrenal (HPA) axis and ultimate release of cortisol are critical in maintaining homeostasis in response to stress. Relative adrenal insufficiency occurs when the HPA axis produces insufficient cortisol for the degree of illness or stress. In some critically ill adult populations, relative adrenal insufficiency is prevalent, 1-4 and is associated with increased morbidity and mortality. 2,3,5 Some studies of glucocorticoid treatment in critically ill adults have shown benefit, with faster reversal of shock and reduction in mortality. 3,[5][6][7][8] Recently, increasing evidence supports the existence of relative adrenal insufficiency in ill newborns, but, similar to other ill populations, there remains no general consensus on which patients should be tested, which tests to use and how to interpret them, which patients should be treated or how they should be treated. 9 The following discussion is an overview of corticosteroid physiology, relative adrenal insufficiency in critically ill populations and evidence of its existence in newborn infants, with proposed underlying

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“…Patients exposed to long-term hydrocortisone therapy are likely to develop adrenal insufficiency secondary to hypothalamic-pituitary-adrenal axis suppression. Although there is evidence of neurodevelopmental impairment after prolonged use of hydrocortisone in ELBW infants (≤1000 gm) [54], the use of low dose hydrocortisone (1 mg/kg/day for 12 days followed by 0.5 mg/kg/day for 3 days) for the treatment of adrenal insufficiency in extremely low birth weight infants has not been found to be associated with an increased incidence of cerebral palsy [55].…”

Section: Long Term (≥2 Weeks)mentioning

confidence: 99%

Neonatal Hypotension, the Role of Hydrocortisone and Other Pharmacological Agents in its Management

2016

J Paediatr Child Care

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pressure at which there is loss of auto-regulation of organ blood flow resulting in tissue ischemia [2]. Shead provides yet another working definition by suggesting that a mean blood pressure less than the neonate's gestational age can be considered hypotension [4]. Hence, there is no clear consensus on the definition for neonatal hypotension. Currently, proper diagnosis and management of neonatal hypotension necessitates the use of clinical judgment following a careful review of physiological parameters. Causes of Neonatal HypotensionNeonatal hypotension is most commonly seen in premature neonates and its incidence is inversely related to the gestational age at delivery [5]. The causes of hypotension in both term and preterm neonates are summarized in Table 2.Hypotension in preterm infants is predominantly due to either abnormal peripheral vaso-regulation or myocardial dysfunction. Hypovolemia as a primary cause is observed less frequently [6]. Since the autonomic nervous system that regulates the peripheral systemic resistance is immature in preterm infants [7], these patients are likely to develop peripheral vasodilatation and hypotension [6]. In addition, the immature myocardium of a preterm infant also has less mitochondria than a term infant. This decreases the ability of the myocardium to adapt from pumping against a low resistance circuit (placenta) to pumping against a high resistance circuit (systemic circulation) after delivery, thus leading to hypotension [4,8].Some other etiologies of hypotension in this population include both physiologic/anatomic factors as well as pathologic factors. Physiologic factors include the presence of a patent ductus arteriosus (PDA) and relative adrenal insufficiency secondary to an immature hypothalamic-pituitary axis (HPA) [9]. Pathologic factors include perinatal depression, maternal chorioamnionitis, hypovolemia

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Growth and Neurodevelopmental Outcomes After Early Low-Dose Hydrocortisone Treatment in Extremely Low Birth Weight Infants

Cited by 145 publications

References 32 publications

Chorioamnionitis: a multiorgan disease of the fetus?

Chorioamnionitis: a multiorgan disease of the fetus?

Relative adrenal insufficiency in the preterm and term infant

Neonatal Hypotension, the Role of Hydrocortisone and Other Pharmacological Agents in its Management

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