Short-term pulmonary and systemic effects of hydrocortisone initiated 7-14 days after birth in ventilated very preterm infants: a secondary analysis of a randomised controlled trial

STOP-BPD Study Grp, Nienke M. Halbmeijer, Wes Onland, Filip Cools, Andre Kroon, Marja van der Heide-jalving, Peter Dijk, Henrica L. M. van Straaten, Arjan B. te Pas, Thilo Mohns, Els Bruneel, Arno F. J. van Heijst, Boris Kramer, Anne Debeer, Inge A. Zonnenberg, Yoann Marechal, Henry Blom, Katleen Plaskie, Maruschka P. Merkus, Martin OffringaAnton H. van Kaam*

*Corresponding author for this work

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    Abstract

    Objective Observational studies in preterm infants suggest that systemic hydrocortisone improves pulmonary condition but may also lead to systemic adverse effects. We report the short-term pulmonary and systemic effects of hydrocortisone initiated in the second week.

    Design Randomised placebo-controlled trial.

    Setting Dutch and Belgian neonatal intensive care units.

    Patients Infants born

    Intervention Infants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).

    Main outcome measures Data on extubation, ventilator settings, glucose levels, and blood pressure were recorded daily and analysed during the first 7 days of treatment using linear mixed-effects models.

    Results Infants in the hydrocortisone group (24.3%) failed extubation less often compared with placebo (38.6%, crude risk difference: -14.3% (95% CI: -23.4% to -4.8%)). The estimated difference in daily rate of change between hydrocortisone and placebo was -0.42 cmH(2)O (95% CI: -0.48 to -0.36) for mean airway pressure, -0.02 (95% CI: -0.02 to -0.01) for fraction of inspired oxygen, -0.37 (95% CI: -0.44 to -0.30) for respiratory index, 0.14 mmol/L (95% CI: 0.08 to 0.21) for blood glucose levels and 0.83 mm Hg (95% CI: 0.58 to 1.09) for mean blood pressure.

    Conclusions Systemic hydrocortisone initiated between 7 and 14 days after birth in ventilated preterm infants improves pulmonary condition, thereby facilitating weaning and extubation from invasive ventilation. The effects of hydrocortisone on blood glucose levels and blood pressure were mild and of limited clinical relevance.

    Original languageEnglish
    Number of pages6
    JournalARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION
    DOIs
    Publication statusE-pub ahead of print - 9-May-2022

    Keywords

    • Neonatology
    • Respiratory Medicine
    • LOW-DOSE DEXAMETHASONE
    • PREVENT BRONCHOPULMONARY DYSPLASIA
    • EARLY ADRENAL INSUFFICIENCY
    • CHRONIC LUNG-DISEASE
    • WEIGHT INFANTS
    • MECHANICAL VENTILATION
    • DOUBLE-BLIND
    • STOP-BPD
    • MULTICENTER
    • THERAPY

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