Related Experiment Videos
Prophylaxis against early adrenal insufficiency to prevent chronic lung disease in premature infants
K L Watterberg1, J S Gerdes, K L Gifford
1Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033-0850, USA. kwatterberg@psghs.edu
Insights
Early hydrocortisone treatment for extremely low birth weight infants improved survival without chronic lung disease (CLD). This benefit was most pronounced in infants with chorioamnionitis, suggesting a potential new therapeutic approach.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Critical Care Medicine
Background:
- Extremely low birth weight infants (<1000 g) often exhibit adrenal insufficiency.
- Adrenal insufficiency in this population correlates with the development of chronic lung disease (CLD).
Purpose of the Study:
- To evaluate if early low-dose hydrocortisone treatment increases survival without CLD in extremely low birth weight infants.
- To assess the impact of hydrocortisone on respiratory support and growth in this vulnerable group.
Main Methods:
- A randomized, double-masked, placebo-controlled pilot study.
- Treatment involved low-dose hydrocortisone (1 mg/kg/day for 9 days, then 0.5 mg/kg/day for 3 days) initiated before 48 hours of life.
- Study success defined as survival without supplemental oxygen at 36 weeks' postconception.
Main Results:
- Hydrocortisone treatment led to a higher rate of survival without CLD (60% vs 35%).
- Treated infants experienced reduced days on supplemental oxygen and mechanical ventilation.
- Benefits were more significant in infants with histologic chorioamnionitis, including improved enteral intake and weight gain.
Conclusions:
- Early low-dose hydrocortisone therapy can improve survival without CLD in extremely low birth weight infants.
- The positive effect of hydrocortisone is particularly evident in infants with chorioamnionitis.
- A larger multicenter trial is recommended to confirm these findings and further assess risks and benefits.
Unlabelled:
BACKGROUND. Many extremely low birth weight infants (<1000 g) show biochemical evidence of adrenal insufficiency in the first week of life, correlating with subsequent development of chronic lung disease (CLD).
Methods:
We conducted a randomized, double-masked, placebo-controlled pilot study to test whether early treatment with low-dose hydrocortisone for 12 days (1 mg/kg/day for 9 days followed by.5 mg/kg/day for 3 days), begun before 48 hours of life, would increase the likelihood of survival without CLD.
Results:
Forty patients were enrolled at two centers. Birth weight and gestation were similar for treatment and placebo groups: 732 +/- 135 g versus 770 +/- 135 g and 25.2 +/- 1.3 weeks versus 25.4 +/- 1.5 weeks. More infants treated with hydrocortisone achieved study success, defined as survival without supplemental oxygen at 36 weeks' postconception (12/20 [60%] vs 7/20 [35%]). Lower birth weight, histologic chorioamnionitis, and preeclampsia were significant risk factors, whereas study center, prenatal steroids, sex, and ethnicity were not significant. Hydrocortisone treatment decreased days on >40% oxygen, days on >25% oxygen, days on ventilator, and oxygen at discharge. Among infants exposed to chorioamnionitis, hydrocortisone treatment also was associated with increased enteral intake during the first month of life and with increased weight at 36 weeks' postconception. Five treated infants and 6 placebo infants developed sepsis; 3 in each group died.
Conclusions:
First, early treatment with low-dose hydrocortisone in this population of extremely low birth weight infants increased the likelihood of survival without CLD. Second, the benefit was particularly apparent in infants with chorioamnionitis. Third, a larger multicenter trial is needed to verify the primary outcome and to better evaluate risks and benefits.