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Hydrocortisone administration in preterm infants is not associated with adverse cardiovascular outcomes in childhood
Cherine Benzouid1, Plamen Bokov2, Pierre Coste3
1Department of Physiology, AP-HP, Robert Debré Hospital, Paris, France.
Insights
Early hydrocortisone administration in extremely preterm infants is not linked to adverse cardiovascular outcomes in childhood. Overweight and obesity, however, are associated with increased cardiovascular risk factors in this population.
Area of Science:
- Neonatal medicine
- Pediatric cardiology
- Clinical trials
Background:
- Assessing the long-term cardiovascular effects of perinatal hydrocortisone administration in extremely preterm infants.
- Investigating potential links between early corticosteroid exposure and later cardiovascular health.
Purpose of the Study:
- To determine if hydrocortisone given during the perinatal period is associated with adverse cardiovascular outcomes in children and adolescents.
- To evaluate cardiovascular parameters in children who received hydrocortisone versus placebo in the PREMILOC trial.
Main Methods:
- Utilized resting blood pressure (BP) measurement, tonometry (pulse wave velocity, aortic systolic BP), continuous BP and ECG monitoring, and ambulatory BP monitoring.
- Calculated heart rate variability (HRV) indices, baroreflex sensitivity (BRS), and orthostatic systolic BP (SBP) response in participants.
- Enrolled 52 subjects (median birth weight 892g, gestational age 26 weeks) with a median age of 11.7 years at assessment.
Main Results:
- No significant differences in pulse wave velocity (PWV), HRV, or BP measurements were found between the hydrocortisone and placebo groups.
- Overweight/obese children (n=17) exhibited higher office SBP, lower supine descending BRS, and a higher orthostatic SBP response compared to other children (n=35).
Conclusions:
- Early hydrocortisone administration in extremely preterm infants is not associated with detrimental cardiovascular indices in childhood.
- Overweight/obesity is identified as a significant factor associated with cardiovascular morbidity in this cohort.
- The study suggests that early markers of hypertension risk are not altered by perinatal hydrocortisone exposure.
Background:
To assess whether administering hydrocortisone in the perinatal period is associated with subsequent adverse cardiovascular outcomes.
Methods:
The children/adolescents enrolled in the PREMILOC trial underwent resting blood pressure (BP) measurement, tonometry evaluation (pulse wave velocity (PWV), aortic systolic BP), continuous BP and ECG measurements (supine and standing), and ambulatory BP monitoring. Heart rate variability (HRV) indices, baroreflex sensitivity (BRS), and orthostatic systolic BP (SBP) response were calculated.
Results:
Fifty-two subjects (median [25th; 75th percentile] birth weight: 892 g [750; 982]; gestational age: 26+3 [25+1; 27+4]; age at assessment: 11.7 years [10.5; 12.7]; z-score of body mass index: 0.23 [-0.65; 1.27]; 27 girls) who received hydrocortisone (n = 28) or placebo (n = 24) were enrolled. The PWV was not different (hydrocortisone: 4.84 m/s [4.40; 5.48] vs. placebo: 5.00 m/s [4.48; 5.34], p = 0.969), and similar results were observed for HRV and BP measurements. Overweight/obese children (n = 17) vs. other children (n = 35) were characterized by higher office SBP, lower supine descending BRS, and higher orthostatic SBP response.
Conclusion:
Early hydrocortisone administration after extremely preterm birth in a randomized trial is not associated with detrimental cardiovascular indices in children/adolescents, while overweight/obesity is already associated with cardiovascular morbidity. The study has been registered, ClinicalTrials.gov ID NCT05451264: https://clinicaltrials.gov/study/NCT05451264?cond=NCT05451264&rank=1 .
Impact:
A meta-analysis on the effects of early postnatal administration of corticosteroids concluded that the hypertensive risk was increased in infants, but that long-term studies should be carried out. We show that early hydrocortisone administration after extremely preterm birth in a randomized trial is not associated with detrimental cardiovascular indices in children/adolescents, at least in one center of the trial Thus, our study suggests that early markers of the risk of hypertension are not altered by hydrocortisone.
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