Neurodevelopmental Follow-Up After Early Low-Dose Hydrocortisone in Extremely Preterm Infants

Summary and Comment |
April 4, 2017

Neurodevelopmental Follow-Up After Early Low-Dose Hydrocortisone in Extremely Preterm Infants

  1. Robin Steinhorn, MD

Low-dose hydrocortisone improves bronchopulmonary dysplasia-free survival in extremely preterm babies, without neurodevelopmental sequelae.

  1. Robin Steinhorn, MD

Bronchopulmonary dysplasia (BPD) is the most frequent morbidity of extreme prematurity. The multicenter French PREMILOC trial recently demonstrated that early low-dose hydrocortisone reduced rates of BPD without increasing short-term morbidity or mortality (NEJM JW Pediatr Adolesc Med 2016 Mar 8; [e-pub] and Lancet 2016; 387:1827). However, the long-term safety of prophylactic hydrocortisone still needs to be confirmed. In a planned follow-up analysis, researchers assessed neurodevelopmental outcomes at 2 years.

The PREMILOC trial randomized 523 extremely preterm infants (<28 weeks' gestation) in the first 24 hours of life to placebo or 1 mg/kg/day of hydrocortisone for 7 days followed by 0.5 mg/kg/day for 3 days. At 36 weeks' postmenstrual age, hydrocortisone significantly improved survival without BPD compared with placebo (60% vs. 51%). In the follow-up analysis of 379 of 406 surviving infants at 2 years of age, rates of neurodevelopmental impairment did not differ significantly between the hydrocortisone and placebo groups (27% and 29%).

Comment

These findings provide important reassurance that prophylactic low-dose hydrocortisone during the first 10 days of life improves outcomes for extremely preterm infants without increasing risk for neurodevelopmental impairment. Given the risks reported in prior studies of steroids administered in alternate forms, in higher doses, or in combination with nonsteroidal anti-inflammatory drugs, the PREMILOC results should be interpreted with caution until they are replicated.

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