Does Hydrocortisone Treatment in Preterm Infants Impact Neurodevelopment?
Because dexamethasone has been associated with long term neurodevelopmental issues when used in very preterm infants, Baud et al. (JAMA, 2017) sought to determine if using hydrocortisone rather than dexamethasone to prevent bronchopulmonary dysplasia was a safe replacement with respect to neurodevelopmental harms. This study was a secondary analysis on a previous study (PREMILOC) that assessed whether hydrocortisone could be used to improve survival in very preterm infants in the setting of bronchopulmonary dysplasia prevention.
Secondary Analysis of a Randomized Controlled Trial (RCT)
To assess the impact of hydrocortisone on neurodevelopment in very preterm infants, 523 infants were given either hydrocortisone (n=256) or a placebo (n=267). Hydrocortisone treatment included 0.5 mg/kg twice a day for seven days, followed by 0.5 mg/kg per day for three days. 406 of the infants survived to age two, and 379 were evaluated (194 in the treatment group and 185 in the control) using a standardized neurological examination and the revised Brunet-Lézine scale. 73% of the treatment group and 70% of the control group had no neurodevelopmental impairment. Mild neurodevelopmental impairment was seen in 20% of the hydrocortisone group and 18% of the placebo group. 7% of the treatment group and 11% of the placebo group had moderate to severe neurodevelopmental impairment. These results were not statistically significant between the groups. Average global development quotient score was not statistically significant between the groups (91.7 in the treatment group and 91.4 in the control group). Rates of cerebral palsy and other major neurological impairments were not significantly different between the groups. The authors conclude that these data indicate that treatment with hydrocortisone does not impact neurodevelopment at two years of age. The authors also suggest for RCTs to make a more definitive assessment of the effects of hydrocortisone on neurodevelopment in extremely preterm infants.
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