hydrocortisone

Infants included in a large study on the use of low-dose hydrocortisone to prevent lung damage in premature babies (the PREMILOC trial) were followed up at 2 years of age to check the development of their nervous system. Researchers found no neurodevelopmental differences between babies who had been treated with low-dose hydrocortisone and those given placebo.

 

Babies who are born very prematurely often have inflammation which can damage their respiratory and nervous systems. In particular, a condition called bronchopulmonary dysplasia (BPD) can develop in babies who need ventilation and oxygen support. This can lead to chronic lung problems which continue into adulthood. BPD can have other consequences such as poor growth, infection and problems with brain development.  Prevention of BPD is an important aspect of caring for premature babies.

Glucocorticoid drugs have been shown to reduce inflammation in other medical conditions and it was suggested that these drugs could be used to prevent BPD in preterm babies. Dexamethasone (a glucocorticoid) has shown some early benefits such as decreasing the time needed for mechanical ventilation and reducing lung damage. However, it was associated with increased incidence of cerebral palsy (a group of conditions which affect movement and muscle tone, caused by brain damage around time of birth) and other adverse effects on the nervous system. As a result, the use this treatment method stopped and focus was put on finding new approach.

It was hypothesized that low-dose hydrocortisone might reduce the development of BDP without any adverse effects on the nervous system. Although early trials were inconclusive, a larger multicenter trial in France between 2008 and 2014 – the PREMILOC trial – found that preterm babies given low-dose hydrocortisone had significantly increased survival without BPD when compared to babies who were given placebo.

The PREMILOC researchers followed the babies involved in the trial to check their neurological development at 2 years of age and recently reported their findings in the Journal of the American Medical Association. They examined several aspects of the infants’ neurological development including movement, coordination, vision, hearing and behavioral problems. 406 of the infants enrolled in the PREMILOC trial survived to 2 years of age and 379 of these infants (93%) underwent examination. The results suggest that infants treated with low-dose hydrocortisone do not have any difference in the development of their nervous system compared to those who had been given placebo.

Although further safety studies are needed, this long-term follow-up suggests that low-dose hydrocortisone therapy in very premature babies is not associated with impaired development of the nervous system in the longer term. This is an important and encouraging result.

 

Written By: Julie McShane

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