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Outcomes after Hydrocortisone 2
Watterberg KL, Shaffer ML, Mishefske MJ, et al. Growth and Neuro-developmental Outcomes After Early Low-Dose Hydrocortisone Treatment in Extremely Low Birth Weight Infants. Pediatrics (July 2007); 120:40-48. [Full text] [PDF]
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.
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.
Comments. Early low-dose hydrocortisone appears to be effective at treating refractory hypotension in ELBW infants (see 2-021). It also appears to be useful in improving survival without BPD in this population, especially if maternal chorioamnionitis is present (see 5-041 and 6-018). The major complication associated with this practice is an increased risk of small bowel perforations, possibly due to an interaction with early indomethacin therapy. We now have additional follow up data demonstrating lack of adverse neuro-developmental outcomes associated with this practice (see also (8-016 and 6-025). In particular, the increased risk of cerebral palsy seen with early dexamethasone treatment was NOT observed in any of the hydrocortisone studies. ABK
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