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Hydrocortisone treatment for bronchopulmonary dysplasia and brain volumes in preterm infants
Karina J Kersbergen1, Linda S de Vries, Britt J M van Kooij
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Hydrocortisone (HC) treatment for bronchopulmonary dysplasia (BPD) did not adversely affect brain growth in infants without dexamethasone exposure. Brain tissue and cerebellar volumes were similar between treated infants and controls at term-equivalent age.
Area of Science:
- Neonatal neuroscience
- Pediatric pharmacology
- Respiratory medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
- Hydrocortisone (HC) is used to treat BPD, but its effects on brain development are debated.
- Previous studies have not conclusively determined HC's impact on brain growth, especially without concurrent dexamethasone exposure.
Purpose of the Study:
- To evaluate the effect of hydrocortisone (HC) treatment on brain growth in infants with bronchopulmonary dysplasia (BPD).
- To compare brain volumes in infants treated with HC for BPD versus matched controls without dexamethasone exposure.
- To assess potential adverse effects of HC on total brain tissue and cerebellar volumes.
Main Methods:
- A cohort of infants treated with HC for BPD between 2005-2011 underwent MRI at term-equivalent age.
- Control infants were matched based on segmentation method, sex, and gestational age.
- Multivariable analysis was used to compare brain volumes, excluding infants with overt parenchymal pathology.
Main Results:
- Seventy-three infants treated with HC and 73 matched controls were analyzed.
- Mean gestational age was 26.7 weeks; mean birth weight was 906 g.
- No significant differences in total brain tissue or cerebellar volumes were observed between HC-treated and control groups after adjusting for relevant covariates.
Conclusions:
- Hydrocortisone treatment for BPD, in the absence of parenchymal brain injury, was not associated with reduced brain tissue or cerebellar volumes.
- These findings suggest HC may be safe for brain development in select BPD infants.
- Further research should explore long-term neurodevelopmental outcomes.
Objective:
To assess whether there was an adverse effect on brain growth after hydrocortisone (HC) treatment for bronchopulmonary dysplasia (BPD) in a large cohort of infants without dexamethasone exposure.
Study Design:
Infants who received HC for BPD between 2005 and 2011 and underwent magnetic resonance imaging at term-equivalent age were included. Control infants born in Geneva (2005-2006) and Utrecht (2007-2011) were matched to the infants treated with HC according to segmentation method, sex, and gestational age. Infants with overt parenchymal pathology were excluded. Multivariable analysis was used to determine if there was a difference in brain volumes between the 2 groups.
Results:
Seventy-three infants treated with HC and 73 matched controls were included. Mean gestational age was 26.7 weeks, and mean birth weight was 906 g. After correction for gestational age, postmenstrual age at time of scanning, the presence of intraventricular hemorrhage, and birth weight z-score, no differences were found between infants treated with HC and controls in total brain tissue or cerebellar volumes.
Conclusions:
In the absence of associated parenchymal brain injury, no reduction in brain tissue or cerebellar volumes could be found at term-equivalent age between infants with or without treatment with HC for BPD.
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