Growth and neurodevelopmental outcomes after early low-dose hydrocortisone treatment in extremely low birth weight infants.

Abstract

BACKGROUND:

Low cortisol concentrations in premature infants have been correlated with increased severity of illness, hypotension, mortality, and development of bronchopulmonary dysplasia. A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a randomized, multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia. Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisone-treated patients exposed to chorioamnionitis. We now report outcomes at 18 to 22 months' corrected age.

PATIENTS AND METHODS:

Surviving infants were evaluated with standardized neurologic examination and Bayley Scales of Infant Development-II. Neurodevelopmental impairment was defined as a Mental Developmental Index or Psychomotor Developmental Index of <70, cerebral palsy, blindness or deafness.

RESULTS:

A total of 252 (87%) of 291 survivors were evaluated. Cerebral palsy was diagnosed in 13% of hydrocortisone-treated versus 14% of placebo-treated infants. Fewer hydrocortisone-treated infants had a Mental Development Index <70, and more of the hydrocortisone-treated infants showed evidence of awareness of object permanence. Incidence of neurodevelopmental impairment was not different (39% [hydrocortisone] vs 44% [placebo]). There were no differences in physical growth measures. Chorioamnionitis-exposed infants treated with hydrocortisone were shorter and weighed less than controls but had no evidence of neurodevelopmental impairment. Among infants not exposed to chorioamnionitis, hydrocortisone-treated patients were less likely to have a Mental Development Index of <70 or to be receiving glucocorticoids at follow-up.

CONCLUSIONS:

Early, low-dose hydrocortisone treatment was not associated with increased cerebral palsy. Treated infants had indicators of improved developmental outcome. Together with the short-term benefit previously reported, these data support additional studies of hydrocortisone treatment of adrenal insufficiency in extremely premature infants.

• Authors: Kristi L Watterberg, Michele L Shaffer, Mary J Mishefske, Corinne L Leach, Mark C Mammel, Robert J Couser, Soraya Abbasi, Cynthia H Cole, Susan W Aucott, Elizabeth H Thilo, Henry J Rozycki, Conra Backstrom Lacy
• Journal: Pediatrics (Pediatrics) Vol. 120 Issue 1 Pg. 40-8 (Jul 2007) ISSN: 1098-4275 [Electronic] United States
• PMID: 17606560 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Dexamethasone
• hydrocortisone hemisuccinate
• Hydrocortisone

Topics

• Adrenal Insufficiency (prevention & control)
• Bronchopulmonary Dysplasia (mortality, therapy)
• Cerebral Palsy (prevention & control)
• Child Development
• Chorioamnionitis (blood)
• Developmental Disabilities (prevention & control)
• Dexamethasone (administration & dosage, adverse effects)
• Female
• Humans
• Hydrocortisone (administration & dosage, adverse effects, analogs & derivatives, blood)
• Infant
• Infant, Extremely Low Birth Weight (growth & development)
• Infant, Newborn
• Intestinal Perforation (chemically induced)
• Male
• Neurologic Examination
• Pregnancy
• Psychomotor Disorders (prevention & control)
• Respiration, Artificial
• Survival Rate