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Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants
Sarah E Dubner1, Lucy Rickerich2, Lisa Bruckert1
1Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA.
Insights
Early low-dose hydrocortisone in extremely preterm infants did not affect brain white matter development. This study found no significant differences in brain connectivity metrics for infants who received hydrocortisone compared to those who did not.
Area of Science:
- Neonatal neuroscience
- Developmental biology
- Pediatric neurology
Background:
- Postnatal steroids are crucial for preventing bronchopulmonary dysplasia in extremely preterm infants.
- However, concerns exist regarding their potential adverse effects on infant brain development.
- This study investigates the impact of early hydrocortisone on brain structure in this vulnerable population.
Purpose of the Study:
- To assess the effect of a standardized hydrocortisone regimen on white matter tract microstructure in extremely preterm infants.
- To compare connectivity metrics between infants who received early postnatal hydrocortisone and those who did not.
- To determine if low-dose hydrocortisone impacts early brain development.
Main Methods:
- Retrospective cohort study of infants born before 28 weeks gestation.
- Comparison of diffusion MRI metrics (mean fractional anisotropy and mean diffusivity) in major white matter tracts.
- Analysis of infants receiving a standardized hydrocortisone protocol versus those who did not.
Main Results:
- No significant differences in mean fractional anisotropy or mean diffusivity were found in cerebral or cerebellar white matter tracts between the groups.
- Infants in both groups were comparable in gestational age, scan timing, and incidence of major medical complications.
- Early low-dose hydrocortisone showed no significant association with white matter microstructure differences.
Conclusions:
- Early, low-dose postnatal hydrocortisone administration was not associated with significant alterations in white matter tract microstructure at near-term gestational age.
- The findings suggest that this regimen does not adversely affect early brain white matter development in extremely preterm infants.
- Hydrocortisone did not demonstrate a significant impact on early brain white matter circuits in this cohort.
Background:
Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life.
Methods:
Retrospective cohort study.
Participants:
Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle.
Results:
Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract.
Conclusion(S):
Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age.
Impact:
This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone. Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways. Hydrocortisone did not have a significant effect on early brain white matter circuits.
