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. Issue 1 (9th May 2022)

• Record Type: Journal Article
• Authors: Halbmeijer, Nienke M; Onland, Wes; Cools, Filip; Kroon, Andre; van der Heide-Jalving, Marja; Dijk, Peter; van Straaten, Henrica L M; te Pas, Arjan B; Mohns, Thilo; Bruneel, Els; van Heijst, Arno F J; Kramer, Boris; Debeer, Anne; Zonnenberg, Inge A; Marechal, Yoann; Blom, Henry; Plaskie, Katleen; Merkus, Maruschka P; Offringa, Martin; van Kaam, Anton H
• Other Names: author non-byline.; Nuytemans Debbie H author non-byline.; Loo Moniek van de author non-byline.; Vereeck Inez author non-byline.; Swarte Renate author non-byline.; Rademaker Karin author non-byline.; Kort Ellen de author non-byline.; Cavartorta Eric author non-byline.; Rassart Anne author non-byline.; Eerdekens An author non-byline.; Stuijvenberg Margriet author non-byline.; Matthijsse René author non-byline.; Boode Willem de author non-byline.; Niemarkt Hendrik author non-byline.; Hattum Ilse van author non-byline.; Jebbink Liesbeth Groot author non-byline.; Mulder-de Tollenaer Susanne M author non-byline.; Tan Ratna author non-byline.; Theyskens Claire author non-byline.; Weissenbruch Mirjam van author non-byline.; Dierckx Elke author non-byline.
• Is Part Of: Archives of disease in childhood. Volume 108:Issue 1(2023)
• Page Start: 20
• Page End: 25
• Publication Date: 2022-05-09
• Subjects: Neonatology -- Respiratory Medicine; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2022-323882
• Languages: English
• ISSNs: 1359-2998

Abstract

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 <30 weeks' gestation and/or birth weight <1250 g, and ventilator dependent in the second week of life. 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 cmH2 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. Trial registration number: Netherlands Trial Register (NTR2768; https://www.trialregister.nl/trial/2640 ) and European Union Clinical Trials Register (EudraCT, 2010-023777-19). Abstract : This paper reports measures of pulmonary wellbeing during the 7 days after starting treatment in 372 infants enrolled in the SToP-BPD trial of early hydrocortisone in preterm infants. Although the trial did not show a significant difference in BPD at 36 weeks, hydrocortisone treatment was associated with improved measures of pulmonary wellbeing after starting treatment and earlier extubation.