Hydrocortisone no solution to Preterm Babies with Bronchopulmonary Dysplasia: NEJM
Bronchopulmonary dysplasia (BPD) remains a leading morbidity of the extremely preterm infant, and prolonged mechanical ventilation is associated with increased risk for BPD. Dexamethasone has been used previously to facilitate extubation and decrease the incidence of BPD; however, due to adverse effects on neurodevelopmental outcomes, the use of this drug has decreased.
A recent study suggest that hydrocortisone does not improve survival in preterms without moderate or severe bronchopulmonary dysplasia than placebo. The study findings were published in The NEW ENGLAND JOURNAL of MEDICINE on March 24, 2022.
Whether hydrocortisone treatment after the second postnatal week can improve survival without bronchopulmonary dysplasia and without adverse neurodevelopmental effects is unknown. Therefore, Dr Kristi L. Watterberg and her team conducted a study to evaluate the efficacy and safety of a 10-day tapering course of hydrocortisone treatment for infants <30 weeks estimated gestational age at birth who remain intubated at 14 - 28 days postnatal age.
In this study, the researchers included 800 infants and randomly assigned to receive either hydrocortisone (4 mg per kilogram of body weight per day tapered over a period of 10 days) or placebo. They specified mandatory extubation thresholds. The major outcome assessed was survival without moderate or severe bronchopulmonary dysplasia at 36 weeks of postmenstrual age. They also assessed the survival without moderate or severe neurodevelopmental impairment at 22 to 26 months of corrected age.
Key findings of the study:
- Upon analysis, the researchers found that the survival without moderate or severe bronchopulmonary dysplasia at 36 weeks occurred in 66 of 398 infants (16.6%) in the hydrocortisone group and in 53 of 402 (13.2%) in the placebo group (adjusted rate ratio, 1.27).
- For 91.0 percent of the infants, two-year outcomes were known.
- They found that the survival without moderate or severe neurodevelopmental impairment occurred in 132 of 358 infants (36.9%) in the hydrocortisone group and in 134 of 359 (37.3%) in the placebo group (adjusted rate ratio, 0.98).
- They also found that hypertension that was treated with medication occurred more frequently with hydrocortisone than with placebo (4.3% vs 1.0%) and further noted that other adverse events were similar in the two groups.
The authors concluded, "In this trial involving preterm infants, hydrocortisone treatment starting on postnatal day 14 to 28 did not result in substantially higher survival without moderate or severe bronchopulmonary dysplasia than placebo. Survival without moderate or severe neurodevelopmental impairment did not differ substantially between the two groups."
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Keywords: Bronchopulmonary dysplasia, BPD, neurodevelopmental impairment, hydrocortisone, postnatal extubation, preterm infants, neurodevelopmental outcomes, Survival rate, The NEW ENGLAND JOURNAL of MEDICINE