Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Pharmacology

Background:

• Extremely low birth weight (ELBW) infants are at high risk for mortality and neurodevelopmental impairments.
• Bronchopulmonary dysplasia (BPD) is a common complication in ventilator-dependent ELBW infants.
• The role of stress dose hydrocortisone in this population remains debated.

Purpose of the Study:

• To evaluate the efficacy of stress dose hydrocortisone versus placebo in reducing death or neurodevelopmental impairment in high-risk preterm infants.
• To assess the impact of hydrocortisone on secondary outcomes such as respiratory support and growth.

Main Methods:

• A randomized controlled trial involving 64 ventilator-dependent ELBW infants (birth weight ≤1000 g) aged 10-21 days.
• Infants received a tapering 7-day course of hydrocortisone or saline placebo.
• Primary outcome: composite of death, cognitive/language delay, cerebral palsy, severe hearing loss, or blindness at 18-22 months corrected age.

Main Results:

• Of 57 infants with adequate data, 68% in the hydrocortisone group and 76% in the placebo group experienced death or impairment (RR 0.83; 95% CI, 0.61-1.14).
• Mortality rates were 31% for hydrocortisone and 41% for placebo (P=0.42), not statistically significant.
• Hydrocortisone did not significantly alter respiratory support needs or medication use.

Conclusions:

• Stress dose hydrocortisone administered after 10 days of age did not significantly impact the composite outcome of death or neurodevelopmental impairment in high-risk ELBW infants.
• These findings may guide future clinical trial designs for interventions in this vulnerable population.