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Cognitive Outcomes of Extremely Preterm Infants at 6.5 Years after Postnatal Corticosteroid Treatment: A Pilot Study
Leena Aho1, Lotta Immeli1, Aulikki Lano2
1Department of Pediatrics, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
High-dose postnatal corticosteroids may impact cognitive development in extremely preterm infants. Further research is needed to understand the long-term safety of these treatments.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Pharmacology
Background:
- Extremely preterm infants face risks of neurodevelopmental impairments.
- Corticosteroids are used to manage inflammation in these infants.
- Early dexamethasone is linked to adverse outcomes, leading to increased hydrocortisone use, but its long-term effects are unknown.
Purpose of the Study:
- To investigate the long-term neurodevelopmental effects of postnatal corticosteroid therapy in extremely preterm infants.
- To assess cognitive outcomes at 6.5 years in relation to hydrocortisone and dexamethasone exposure.
- To evaluate the safety of current corticosteroid treatment protocols.
Main Methods:
- A pilot study followed 66 extremely preterm infants for 6.5 years.
- Cumulative doses of hydrocortisone and dexamethasone were recorded.
- Cognitive function was assessed using standardized intelligence tests.
Main Results:
- No significant differences in mean intelligence quotients (Full-scale, Performance, Verbal) were found between treated and untreated groups.
- A higher incidence of cognitive impairment was observed in the corticosteroid-treated group, though not statistically significant.
- 44% of children received corticosteroid treatment.
Conclusions:
- High-dose postnatal corticosteroids may be associated with long-term adverse cognitive effects.
- Further longitudinal studies are essential to confirm the safety of corticosteroid treatments.
- The findings highlight the need for careful consideration of corticosteroid use in extremely preterm infants.
Introduction:
Extremely preterm-born infants are at risk for neurodevelopmental impairments. Corticosteroids are used to reduce systemic inflammation. Early dexamethasone therapy is associated with poorer neurodevelopmental outcomes; thus, hydrocortisone is currently widely used. However, the long-term effects of hydrocortisone treatment on neurodevelopmental outcomes remain unclear, and thus, we conducted a pilot study of extremely preterm infants.
Methods:
The study cohort included 66 extremely preterm-born infants, who were followed up for 6.5 years. Data on corticosteroid treatment were collected from medical records, and the cumulative doses of hydrocortisone and dexamethasone were calculated. Cognitive outcomes at 6.5 years were assessed using a standardized test of intelligence, and the associations with corticosteroid therapy were evaluated.
Results:
Twenty-nine (44%) children were treated with corticosteroids, 18 with hydrocortisone, 3 with dexamethasone, and 8 with hydrocortisone and dexamethasone. The mean full-scale (FSIQ), performance (PIQ) and verbal (VIQ) intelligence quotients did not differ significantly between children treated with corticosteroids and those not treated at 6.5 years. The incidence of cognitive impairment (FSIQ, PIQ, and VIQ <85) was higher in children treated with corticosteroids than in those not treated. However, the difference was not statistically significant.
Conclusion:
This pilot study indicates that high-dose postnatal corticosteroid treatment may have long-term adverse effects on cognitive development. Longitudinal studies of the long-term effects of corticosteroid treatment are required to clarify their safety.
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