Association between Baseline Cortisol Serum Concentrations and the Effect of Prophylactic Hydrocortisone in Extremely...

Area of Science:

• Neonatalogy
• Endocrinology
• Pediatric Critical Care

Background:

• Extremely preterm infants often require interventions for survival and to prevent morbidities.
• Serum cortisol levels in neonates may influence outcomes, but their role in relation to prophylactic hydrocortisone is not fully understood.
• Establishing nomograms for early postnatal serum cortisol is crucial for understanding its impact on extremely preterm infants.

Purpose of the Study:

• To establish nomograms for serum cortisol values within 24 hours of birth in extremely preterm infants.
• To determine if baseline cortisol levels affect the benefit/risk ratio of prophylactic hydrocortisone for BPD-free survival.
• To investigate the association between early cortisol levels and adverse outcomes in infants receiving hydrocortisone.

Main Methods:

• Secondary analysis of the multicenter randomized controlled PREMILOC trial.
• Inclusion of inborn infants delivered before 28 weeks of gestation.
• Development of sex-specific nomograms for baseline serum cortisol values in 325 neonates.
• Analysis of BPD-free survival and severe adverse events using multivariate logistic regression based on cortisol z-scores.

Main Results:

• Higher baseline cortisol levels were associated with increased BPD-free survival in placebo-treated infants (aOR 1.57 [1.08-2.27]).
• In infants treated with prophylactic hydrocortisone, elevated cortisol z-scores predicted higher risks of severe intraventricular hemorrhage (aOR 1.82 [1.06-3.15]) and spontaneous intestinal perforation (aOR 4.81 [1.34-17.22]).
• No predictive value of baseline cortisol for BPD-free survival was found in hydrocortisone-treated infants.

Conclusions:

• Baseline serum cortisol levels do not predict BPD-free survival in extremely preterm infants treated with hydrocortisone.
• High early postnatal cortisol levels in infants receiving hydrocortisone are linked to an increased risk of severe intraventricular hemorrhage and spontaneous intestinal perforation.
• The findings suggest a potentially lower benefit/risk ratio for prophylactic hydrocortisone in extremely preterm infants with high early cortisol levels.