Developmental outcome of very low birth weight infants treated with hydrocortisone for refractory hypotension

Abstract

Background: Hypotension is a common problem in infants born prematurely and is associated with significant adverse events including increased risk for death, IVH, and adverse neurodevelopment. It has been postulated that relative or absolute adrenocortical insufficiency may be partly responsible for hypotension. This has lead to the widespread use of hydrocortisone as treatment for refractory hypotension. Several studies have documented the ability of hydrocortisone to increase blood pressure in the hypotensive newborn, but there is a paucity of information regarding its long term effect on neurodevelopment.

Objective: In 2001, our neonatology group established a protocol for the administration of hydrocortisone for the treatment of hypotension refractory to inotropes. The primary aim of this study is to evaluate neurodevelopment at 12 months corrected age (CGA) as assessed by the Mental development Index and Psychomotor development Index (MDI/PDI) components of the Bayley Scales of Infant Development (BSID).

Design/methods: Retrospective matched case-control study of VLBW infants treated with hydrocortisone according to protocol (n = 17) between 2002 and 2005 and BSID score at 12 months corrected age (CGA). Infants were matched on birth weight (BW), ± 300g and none/mild IVH (grades 0, I, II) versus severe (grades III, IV).

Results: Hydrocortisone exposed infants were significantly different from the no HC group in gestational age (GA), SNAPPE-II, inotrope score, incidence of PDA , days of mechanical ventilation, and ROP surgery. GA, SNAPPE-II, PDA, and ventilation days were independently significantly correlated with the primary outcome of MDI/PDI. Inotrope score was also significantly correlated with MDI. These variables were included as confounders in the multiple linear regression models. HC use was not a significant predictor of MDI (p = 0.7604) or PDI (p = 0.5593) after adjusting for GA, Inotrope score, SNAPPE-II, ventilator days and PDA by multiple linear regression.

Conclusions: HC was not a significant predictor of MDI/PDI scores at 12 months CGA when controlling for a large number of predictors of abnormal neurodevelopment.