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Total hydrocortisone dosage in extremely low birth weight infants and neurodevelopment up to school age

Akinobu Taniguchi1, Basile Chrétien2, Takashi Maeda3

  • 1Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. akinobut7@nagoya-u.jp.

Pediatric Research
|September 23, 2025
PubMed

Insights

Higher hydrocortisone (HC) doses in extremely low birth weight (ELBW) infants are linked to lower developmental and intelligence quotient (DQ/IQ) scores, a trend that persists into school age. This highlights a potential dose-dependent neurodevelopmental effect of HC treatment.

Area of Science:

  • Neonatal medicine
  • Pediatric neurology
  • Pharmacology

Background:

  • The long-term neurodevelopmental effects of hydrocortisone (HC) in extremely low birth weight (ELBW) infants are not fully understood.
  • HC is used as an alternative to dexamethasone for glucocorticoid treatment in ELBW infants.

Purpose of the Study:

  • To investigate the association between total neonatal hydrocortisone (HC) dosage and neurodevelopmental outcomes up to school age in ELBW infants.
  • To determine if the effects of HC on neurodevelopment are dose-dependent and sustained over time.

Main Methods:

  • A retrospective longitudinal cohort study was conducted across eight Japanese centers.
  • Included ELBW infants born between 2015 and 2017.
  • Total HC dosage up to 36 weeks postmenstrual age was analyzed against neurodevelopmental outcomes assessed up to school age.

Main Results:

  • Higher total HC dosage was significantly associated with lower developmental and intelligence quotient (DQ/IQ) scores.
  • This association persisted at 6 years of age, indicating a sustained effect on cognitive outcomes.
  • For every 10 mg increase in HC dosage, IQ scores decreased by 2.82 points (p=0.001).

Conclusions:

  • A significant relationship exists between total neonatal HC dosage in ELBW infants and long-term DQ/IQ scores.
  • Clinicians should consider the potential dose-dependent neurodevelopmental effects of HC when managing ELBW infants.
  • The findings underscore the importance of careful HC dosage management in this vulnerable population.
Abstract

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