Original article
Neonatal Hydrocortisone Treatment: Neurodevelopmental Outcome and MRI at School Age in Preterm-born Children

https://doi.org/10.1016/j.jpeds.2006.10.051Get rights and content

Objective

To investigate neurodevelopment at school age in preterm infants treated with hydrocortisone for bronchopulmonary dysplasia (BPD) in the neonatal period.

Study design

Preterm infants (n = 226; gestational age ≤32 weeks and/or body weight ≤1500 grams) performed subtests of the Wechsler Intelligence Scale for Children-Revised, the Visual Motor Integration test, a 15-Word Memory Test and the Movement Assessment Battery for Children at school age. Conventional MRI of the brain was obtained. Sixty-two children who received hydrocortisone for BPD (starting dose, 5 mg/kg/day; median duration, 27.5 days) were compared with 164 nontreated neonates.

Results

Hydrocortisone-treated infants were younger, lighter, and sicker than their non–steroid-treated counterparts. Adjustments for gestational age, body weight, sex, mechanical ventilation, and small for gestational age were made. Adjusted mean Intelligence Quotient, Visual Motor Integration test, and memory test results were the same in the hydrocortisone-treated group and the non–steroid-treated group (99 versus 101, P = .62; 97 versus 99, P = .49, 7.9 versus 7.5, P = .42, respectively). Motor function and incidence of cerebral palsy in both groups was not different (11% versus 7%, P = .97). Occurrence of brain lesions on MRI was similar for the two groups.

Conclusions

Neonatal hydrocortisone treatment for BPD had no long-term effects on neurodevelopment.

Section snippets

Methods

The children studied are part of a cohort of consecutively admitted patients soon after birth over a period of 2 years to the neonatal intensive care unit (NICU) of the Wilhelmina Children’s Hospital, a tertiary referral center. All children, born between March 1, 1991, and March 1, 1993, with a gestational age (GA) ≤32 weeks (range, 25.0 to 33.0) and/or a birth weight (BW) ≤1500 grams, were subsequently enrolled in a long-term follow-up study. The original group consisted of 375 children.

Patient Characteristics

Mean GA of steroid-treated children was less and mean BW was lower compared with children who never received steroids (Table I). Treated children were also sicker, as shown by a significantly higher incidence of mechanical ventilation, need for surfactant and inotropes, and an increased incidence of patent ductus arteriosus (PDA). There was no difference in the proportion of mothers of steroid-exposed and non–steroid-exposed children who had received a complete course of antenatal betamethasone

Discussion

The findings of this cohort study of 226 preterm-born children followed up for 8 years do not demonstrate any unfavorable structural or functional effects of neonatal treatment with hydrocortisone on brain development at school age. To appreciate these results, some issues need to be addressed. We estimated the effects of treatment by using data obtained in routine care rather than conducting a randomized trial. Consequently, children who were treated had clinical indication for treatment.

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    This study was supported by University Medical Center Utrecht (Zonproject).

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