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Early low-dose hydrocortisone: is the neurodevelopment affected?

Gaston Ofman1, Marta Perez2, Kathryn N Farrow2

  • 1Northwestern University Feinberg School of Medicine, Chicago, IL, USA. gaston.ofman@northwestern.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|February 23, 2018
PubMed
Summary

Early low-dose hydrocortisone in extremely preterm infants did not significantly impact neurodevelopmental outcomes at two years. This finding suggests hydrocortisone treatment is not associated with adverse neurodevelopmental effects in this vulnerable population.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Neurology
  • Clinical Trials

Background:

  • Extremely preterm infants (<28 weeks gestation) face high risks of neurodevelopmental impairment.
  • Early interventions are crucial to improve outcomes in this population.
  • The neurodevelopmental effects of early low-dose hydrocortisone in extremely preterm infants remain an area of investigation.

Purpose of the Study:

  • To investigate the association between early low-dose hydrocortisone and neurodevelopmental impairment at two years of age in extremely preterm infants.
  • To analyze the exploratory secondary outcomes of a randomized controlled trial (PREMILOC).

Main Methods:

  • An exploratory secondary analysis of the PREMILOC trial, a double-blind, multicenter, randomized, placebo-controlled study.
  • Infants born between 24 0/7 and 27 6/7 weeks gestation received either low-dose hydrocortisone or placebo for 10 days.
  • Neurodevelopmental outcomes were assessed at 22 months corrected age.

Main Results:

  • No statistically significant differences were observed in the rates of no neurodevelopmental impairment (73% vs. 70%), mild impairment (20% vs. 18%), or moderate to severe impairment (7% vs. 11%) between the hydrocortisone and placebo groups (p=0.33).
  • Qualitative neurological assessments also showed no significant differences between the groups (p=0.87).

Conclusions:

  • Early low-dose hydrocortisone treatment in extremely preterm infants was not associated with adverse neurodevelopmental effects at 22 months corrected age.
  • These findings support the safety of this hydrocortisone regimen regarding neurodevelopmental outcomes in this population.