The Effect of Hydrocortisone on Neurodevelopmental Outcome in Premature Infants Less than 29 Weeks’ Gestation

Needelman, Howard; Hoskappal, Arvind; Roberts, Holly; Evans, Martha

doi:10.1177/0883073809348059

Cited by 14 publications

(16 citation statements)

References 14 publications

(17 reference statements)

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“…(16) However, when considering duration of therapy in a different cohort by 2 years, longer treatment with hydrocortisone (more than 7 days) was associated with worse developmental outcome. (21)…”

Section: Discussionmentioning

confidence: 99%

“…(13) However, such findings have not been clearly corroborated with hydrocortisone exposure. While one study raised concerns of motor and cognitive deficits in children with over a week of hydrocortisone therapy,(14) other studies have not reported abnormalities of brain development with hydrocortisone therapy in preterm newborns, resulting in their continued clinical use. (15, 16)…”

Section: Introductionmentioning

confidence: 99%

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Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids

et al. 2011

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With improving survival rates of preterm newborns, adverse cognitive outcomes are increasingly recognized. Adverse cognitive outcomes are associated with decreased cerebellar volumes, and modifiable risk factors for these adverse outcomes should be identified. Animal models demonstrate reduced preterm cerebellar growth after exposure to glucocorticoids. Preterm neonates were prospectively studied with serial MRI examinations near birth and again near term-equivalent age. Adjusting for associated clinical factors, antenatal bethamethasone was not associated with changes in cerebellar volume. Postnatal exposure to clinically routine doses of hydrocortisone or dexamethasone were associated with impaired cerebellar, but not cerebral, growth. Modifying postnatal risk factors for impaired cerebellar development, and particularly glucocorticoid exposure, may help to decrease risk for adverse neurological outcome after preterm birth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids

et al. 2011

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“…There are no published data about the long‐term effects of BTM, but we previously reported significant flow reduction in the anterior cerebral artery of preterm infants after BTM administration , which was not observed after HC administration . In comparison with untreated preterm infants, patients who have received HC do not present a higher rate of brain lesions or abnormal cognitive or motor development .…”

Section: Introductionmentioning

confidence: 93%

“…The z-score for body weight showed significantly greater loss in BTM group than HC group. untreated preterm infants, patients who have received HC do not present a higher rate of brain lesions or abnormal cognitive or motor development (8,(12)(13)(14)(15).…”

Section: Key Notesmentioning

confidence: 99%

Postnatal steroids in extremely low birth weight infants: betamethasone or hydrocortisone?

et al. 2013

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“…Consequently, early physiological replacement of cortisol may be needed in extremely premature infants68). Retrospective studies and RCTs of early hydrocortisone replacement for CLD within the first week of life have been performed on the basis of this relative adrenal insufficiency69,70,71,72,73,74,75,76,77,78,79,80). Hydrocortisone is also being used increasingly for the treatment or prevention of vasopressor-resistant hypotension in extremely premature infants68).…”

Section: Clinical Evidence For Adverse Effects Of Postnatal Gcs On Thmentioning

confidence: 99%

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

Chang

2014

Korean J Pediatr

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The use of glucocorticoids (GCs) in the perinatal period is suspected of being associated with adverse effects on long-term neurodevelopmental outcomes for preterm infants. Repeated administration of antenatal GCs to mothers at risk of preterm birth may adversely affect fetal growth and head circumference. Fetal exposure to excess GCs during critical periods of brain development may profoundly modify the limbic system (primarily the hippocampus), resulting in long-term effects on cognition, behavior, memory, co-ordination of the autonomic nervous system, and regulation of the endocrine system later in adult life. Postnatal GC treatment for chronic lung disease in premature infants, particularly involving the use of dexamethasone, has been shown to induce neurodevelopmental impairment and increases the risk of cerebral palsy. In contrast to studies involving postnatal dexamethasone, long-term follow-up studies for hydrocortisone therapy have not revealed adverse effects on neurodevelopmental outcomes. In experimental studies on animals, GCs has been shown to impair neurogenesis, and induce neuronal apoptosis in the immature brains of newborn animals. A recent study has demonstrated that dexamethasone-induced hypomyelination may result from the apoptotic degeneration of oligodendrocyte progenitors in the immature brain. Thus, based on clinical and experimental studies, there is enough evidence to advice caution regarding the use of GCs in the perinatal period; and moreover, the potential long-term effects of GCs on brain development need to be determined.

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The Effect of Hydrocortisone on Neurodevelopmental Outcome in Premature Infants Less than 29 Weeks’ Gestation

Cited by 14 publications

References 14 publications

Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids

Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids

Postnatal steroids in extremely low birth weight infants: betamethasone or hydrocortisone?

Evidence for adverse effect of perinatal glucocorticoid use on the developing brain

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