Abstract
Background
Extremely low birth weight (ELBW) infants comprise a fragile population at risk for neurodevelopmental disabilities (NDD). Systemic steroids were previously associated with NDD, but more recent studies suggest hydrocortisone (HCT) may improve survival without increasing NDD. However, the effects of HCT on head growth adjusted for illness severity during NICU hospitalization are unknown. Thus, we hypothesize that HCT will protect head growth, accounting for illness severity using a modified neonatal Sequential Organ Failure Assessment (M-nSOFA) score.
Methods
We conducted a retrospective study that included infants born at 23–29 weeks gestational age (GA) and < 1000 g. Our study included 73 infants, 41% of whom received HCT.
Results
We found negative correlations between growth parameters and age, similar between HCT and control patients. HCT-exposed infants had lower GA but similar normalized birth weights; HCT-exposed infants also had higher illness severity and longer lengths of hospital stay. We found an interaction between HCT exposure and illness severity on head growth, such that infants exposed to HCT had better head growth compared to those not exposed to HCT when adjusted for illness severity.
Conclusion
These findings emphasize the importance of considering patient illness severity and suggest that HCT use may offer additional benefits not previously considered.
Impact
-
This is the first study to assess the relationship between head growth and illness severity in extremely preterm infants with extremely low birth weights during their initial NICU hospitalization.
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Infants exposed to hydrocortisone (HCT) were overall more ill than those not exposed, yet HCT exposed infants had better preserved head growth relative to illness severity.
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Better understanding of the effects of HCT exposure on this vulnerable population will help guide more informed decisions on the relative risks and benefits for HCT use.
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Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We thank the families of the participants and the staff at Johns Hopkins Hospital and laboratory for their willingness to participate in this study.
Funding
Supported by National Institutes of Health RO1HD086058 (A.E., F.J.N.); R01 HD110091 (F.J.N., A.D.E., K.Z., R.C-V.); RO1HD070996, AG061643, and NS109029, HD074593-07 (F.J.N.); KO8NS096115 (R.C-V.), and the Thomas Wilson Foundation (R.-V.).
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H.C., K.B.A., R.C-V. conceived and designed the study, analyzed the data, and drafted the article. H.C., K.B.A, H.S., S.M., A.S., S.B., A.D.E., F.J.N and R.C-V. contributed to acquisition of the data. M.G. and A.K. performed the HUS measurements. H.C., K.B.A., A.S., S.B., A.D.E., C.E.S., and R.C-V. provided critical revisions. All authors provided final approval of the version to be published.
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The study received institutional review board approval (JHH IRB 00026068), and signed parental informed consent was obtained for each participant within the infant’s first 30 days of life and prior to NICU discharge.
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Chen, H., Aziz, K.B., Spahic, H. et al. Interaction of hydrocortisone and illness severity on head growth in cohort of ELBW infants. Pediatr Res 94, 1958–1965 (2023). https://doi.org/10.1038/s41390-023-02689-w
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DOI: https://doi.org/10.1038/s41390-023-02689-w