Trial of early neonatal hydrocortisone: two-year follow-up.
Author(s): Peltoniemi OM, Lano A, Puosi R, Yliherva A, Bonsante F, Kari MA, Hallman M, Neonatal Hydrocortisone Working Group
Affiliation(s): Department of Pediatrics, University of Oulu, Oulu, Finland. outi.peltoniemi@mail.suomi.net
Publication date & source: 2009, Neonatology., 95(3):240-7. Epub 2008 Oct 17.
Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't
BACKGROUND: Dexamethasone treatment is associated with an increased risk of cerebral palsy (CP). Early hydrocortisone (HC) treatment may decrease the incidence of bronchopulmonary dysplasia; however, the long-term effects are still under evaluation. Follow-up of randomized studies concerning early HC treatment is essential to confirm the long-term safety. OBJECTIVE: We hypothesized that early HC treatment in very preterm infants does not impair the neurologic outcome. METHODS: We report follow-up data from a randomized trial of early HC given for 10 days. Before the HC or placebo treatment, serum cortisol levels were measured. Receiver-operating characteristic was defined. Values below the median were classified as low endogenous cortisol and those above the median as high endogenous cortisol. A meta-analysis was performed. RESULTS: Altogether 98% of the 46 surviving infants participated in a follow-up study at a corrected age of 2 years. The growth characteristics were similar between the study groups. The developmental quotients (DQs) of the children with high endogenous cortisol and placebo treatment shortly after birth (100 +/- 13) and those with low endogenous cortisol and HC (97 +/- 7) were not lower than the DQs of the children with high endogenous cortisol and HC (92 +/- 3) or low cortisol and placebo (96 +/- 2). According to a meta-analysis of three available trials (411 children), the rate of CP and survival without neurosensory or cognitive impairment was not influenced by HC. CONCLUSION: Early low-dose HC administration had no adverse effects at 2 years of age. Further studies are required to define the target group for neonatal HC.
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