Related Experiment Videos
Depressed T cells following neonatal steroid treatment
Insights
Early hydrocortisone treatment for respiratory distress syndrome may cause lasting immune system changes and increase infection risk in children. Further research is needed to understand these effects.
Area of Science:
- Neonatal Medicine
- Immunology
- Pediatric Infectious Diseases
Background:
- Respiratory distress syndrome (RDS) is a common neonatal condition.
- Hydrocortisone is sometimes used in treating RDS.
- Long-term effects of early-life steroid exposure require investigation.
Purpose of the Study:
- To assess the long-term effects of neonatal hydrocortisone therapy for RDS.
- To evaluate growth, neurodevelopment, and immunologic status at 5 years of age.
- To determine the incidence of infections in steroid-treated versus placebo groups.
Main Methods:
- 44 infants received hydrocortisone or placebo on day 1 of life.
- Survivors were followed up at 5 years for growth, cognitive, and neurological assessments.
- Immunologic tests included lymphocyte subsets, antibody titers, and complement levels.
- Infection episodes (otitis, pneumonia) were documented between ages 1 and 5.
Main Results:
- No significant differences in growth, intelligence, or neurological exams between groups.
- Abnormal EEGs were present in both steroid and placebo groups.
- Steroid group showed reduced T lymphocytes (53% vs 69%) and increased C3 receptor-bearing lymphocytes (20.1% vs 13.8%).
- Steroid-treated patients had a higher incidence of otitis/pneumonia (8/11 vs 2/7).
Conclusions:
- Neonatal hydrocortisone at high doses may lead to persistent immunologic alterations.
- This treatment may increase susceptibility to infections in early childhood.
- Long-term safety and immunologic consequences of early steroid use warrant caution.
Abstract:
Fourty-four patients received two doses of 12.5 mg/kg of hydrocortisone or placebo on the first day of life in attempted therapy for respiratory distress syndrome. Follow-up studies were performed on survivors at 5 years of age in ten steroid-treated and seven placebo-treated respiratory distress syndrome subjects. There were no significant differences in growth, intelligence tests, or neurologic examinations in the patients assessed. Abnormal EEGs are present in both groups. Immunologic tests showed no differences in lymphocyte counts, immunoglobulin levels, diphtheria and tetanus antibody titers, or complement components. Diminished percentages of T lymphocytes were found in steroid patients (53%) compared to control subjects (69%). There were also increased percentages of lymphocytes with C3 receptors in steroid patients (20.1%) compared to control patients (13.8%). Episodes of otitis and/or pneumonia were documented in eight of 11 steroid-treated patients between the ages of 1 and 5 years, compared to two of seven patients in the placebo group in the same time period. It is concluded that large doses of steroids on the first day of life may induce lasting immunologic abnormalities and may predispose to an increased incidence of infections.