Outcomes after Hydrocortisone  

Lodygensky GA, Rademaker K, Zimine S, et al. Structural and Functional Brain Development after Hydrocortisone Treatment for Neonatal Chronic Lung Disease.  Pediatrics (July 2005); 116:1-7. 

Objective. This study evaluated long-term effects of prematurity itself and of neonatal hydrocortisone treatment on structural and functional brain development using three-dimensional MRI with advanced image-processing and neurocognitive assessments.  

Methods. Sixty children born preterm, including 25 children treated with hydrocortisone and 35 children not treated with hydrocortisone, and 21 children born at term were evaluated, at a mean age of 8 years, with quantitative MRI and neurocognitive assessments (Wechsler Intelligence Scales for Children-Revised [WISC-R]). Neonatal hydrocortisone treatment for chronic lung disease consisted of a starting dose of 5 mg/kg per day tapered over a minimum of 3 weeks.  

Results. Cerebral gray matter volume was reduced among preterm children (regardless of hydrocortisone treatment), compared with children born at term. Cerebrospinal fluid volume was increased among children born preterm, compared with children born at term. Total hippocampal volume tended to be lower among children born preterm, with a more pronounced reduction of hippocampal volume among boys.  The WISC-R score was lower for children born preterm, compared with children born at term (preterm: 99.4 ± 12.4; term: 109.6 ± 8.8). Children treated with neonatal hydrocortisone had very similar volumes of gray matter, white matter, and cerebrospinal fluid compared with untreated infants. The hippocampal volumes were similar in the 2 groups. The WISC-R score assessments were within the normal range for both groups, with no difference between the groups (preterm with hydrocortisone: 100.8 ± 13; preterm without hydrocortisone: 98.6 ± 12.3).  

Conclusions. Prematurity is associated with mild brain structural differences that persist at 8 years of age, with associated lower scores in neurocognitive assessments. The data suggest that perinatal hydrocortisone given at the described dosage has no long-term effects on either neurostructural brain development or neurocognitive outcomes.

Comments:  It appears that hydrocortisone (at the dosage described) may be safer than dexamethasone for the treatment for chronic lung disease in premature infants. No long-term problems with brain development or Neurocognitive outcomes were seen after hydrocortisone use.  ABK