Neurocognitive outcomes at age 5 years after prophylactic hydrocortisone in infants born extremely preterm.

Abstract

AIM:

To assess the 5-year neurocognitive outcomes of children born extremely preterm exposed to prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia.

METHOD:

This was a prespecified secondary analysis of the PREMILOC clinical trial (trial registration: EudraCT no. 2007-002041-20, NCT00623740). The primary outcome was full-scale IQ based on the Wechsler Preschool and Primary Scale of Intelligence.

RESULTS:

Among 109 surviving children recruited at the Robert Debré Children's Hospital, Paris, outcome data were available for 42 out of 56 infants (75%) in the group treated with hydrocortisone and 41 out of 53 (77%) in the placebo group. Mean scores were not significantly different between the two groups on full-scale IQ (hydrocortisone: 91.9 [SD = 13.9], placebo: 86.3 [SD = 15.4]; mean difference = 5.7, 95% confidence interval [CI] = -1.0 to 12.3, p = 0.10); however, working memory and retention ability were significantly better in the group treated with hydrocortisone. In a multivariate logistic regression including potential confounding variables, hydrocortisone treatment was significantly associated with a greater chance to survive at 5 years of age with a full-scale IQ equal to or greater than 90 compared to placebo (adjusted odds ratio = 4.26, 95% CI = 1.47-12.36, p = 0.008).

INTERPRETATION:

This exploratory analysis provides reassuring data regarding the long-term neurodevelopmental safety of prophylactic hydrocortisone in infants born extremely preterm.

• Authors: Clémence Trousson, Artemis Toumazi, Aurélie Bourmaud, Valérie Biran, Olivier Baud
• Journal: Developmental medicine and child neurology (Dev Med Child Neurol) Vol. 65 Issue 7 Pg. 926-932 (07 2023) ISSN: 1469-8749 [Electronic] England
• PMID: 36417367 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 Mac Keith Press.

Chemical References

• Hydrocortisone

Topics

• Child
• Child, Preschool
• Humans
• Infant
• Infant, Newborn
• Bronchopulmonary Dysplasia (prevention & control, drug therapy)
• Hydrocortisone (therapeutic use)
• Infant, Extremely Premature
• Logistic Models