Prophylactic hydrocortisone in extremely preterm infants and brain MRI abnormality

Area of Science:

• Neonatalogy
• Pediatric Neurology
• Medical Imaging

Background:

• Extremely preterm infants often receive early hydrocortisone for various conditions.
• The potential impact of this treatment on brain development, particularly white matter, requires thorough investigation.
• Magnetic resonance imaging (MRI) at term equivalent age (TEA) is a key tool for assessing brain injury in this population.

Purpose of the Study:

• To investigate the association between early low-dose hydrocortisone treatment and brain damage in extremely preterm infants.
• To evaluate brain abnormalities using MRI at TEA, specifically focusing on white matter (WM) and overall brain lesions.
• To analyze secondary outcomes from the PREMILOC trial, utilizing Kidokoro scoring for brain lesion grading.

Main Methods:

• A secondary analysis of the PREMILOC trial data was conducted.
• Infants were randomly assigned to receive either placebo or hydrocortisone.
• Brain abnormalities were assessed by MRI at TEA and graded using Kidokoro scores.

Main Results:

• Among 300 analyzed MRIs, no significant difference in WM subscores was found between hydrocortisone and placebo groups.
• A higher overall Kidokoro score was significantly associated with hydrocortisone treatment (p=0.04).
• However, multivariate analysis revealed no statistically significant association between hydrocortisone and moderate-to-severe brain lesions (adjusted OR 1.27; p=0.38). Bronchopulmonary dysplasia independently predicted WM and global brain damage.

Conclusions:

• Early low-dose hydrocortisone treatment is not statistically linked to white matter brain damage or overall moderate-to-severe brain lesions in extremely preterm infants when adjusted for confounding factors.
• Bronchopulmonary dysplasia emerged as a significant predictor of both white matter and global brain damage in this cohort.