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Hydrocortisone and CLD
Bonsante F, Latorre G, Iacobelli S. et al: Early Low-Dose Hydrocortisone in Very Preterm Infants: A Randomized, Placebo-Controlled Trial. Neonatology 2007;91:217–221 Article (References) Article (PDF)
Objective: Our aim was to assess whether Hydrocortisone is able to increase survival without chronic lung disease.
Methods. We performed a double-blind, randomized, placebo-controlled trial. Fifty mechanically ventilated infants (birth weight: 500–1,249 g) were randomized to receive treatment (HC 0.5 mg/kg/12 h for 9 days, then HC 0.5 mg/kg/24 h for 3 days) or placebo. Major outcome was survival without oxygen dependence at 36 weeks of postconceptional age (O 2 -free survival).
Results. The basic characteristics were similar between the two groups. O 2 –free survival was higher in the HC group (64 vs. 32%). The advantage was particularly evident among infants without antenatal steroids. The mortality rate was 16% in the HC group versus 40% in the control group (difference not significant). Hypotension after recruitment was reduced by HC (0 vs. 30%). The incidence of gastrointestinal perforation and other adverse effects was similar between the two groups.
Conclusions. HC prophylaxis improved O 2 -free survival and early cardiocirculatory function in our population, without important short-term effects. The neurodevelopmental outcome will be assessed at 2 years.
Comments. This study showed that O2 -free survival was significantly higher in the HC group. Furthermore, the effect of HC was particularly evident in the subgroup without maternal steroid prophylaxis. It also showed that none of the infants in the HC group had hypotension. Although this study was not powerful enough to rule out a type II error, but it has a message that needs to be tested in a larger trial that also will evaluate possible effects on adverse outcomes, such as sepsis, particularly yeast infections, before this treatment can be recommended. SAA
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