AI Article Synopsis
- Low cortisol levels in premature infants are linked to more severe illnesses and higher mortality rates, prompting a study on hydrocortisone treatment to prevent complications like bronchopulmonary dysplasia.
- Out of 291 survivors assessed at 18 to 22 months, hydrocortisone treatment led to improved awareness and fewer instances of low Mental Developmental Index scores, although overall neurodevelopmental impairment rates were similar to the placebo group.
- While some physical growth differences were noted in chorioamnionitis-exposed infants, hydrocortisone treatment did not increase the risk of cerebral palsy, indicating potential long-term developmental benefits.
Article Abstract
Background: Low cortisol concentrations in premature infants have been correlated with increased severity of illness, hypotension, mortality, and development of bronchopulmonary dysplasia. A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a randomized, multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia. Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisone-treated patients exposed to chorioamnionitis. We now report outcomes at 18 to 22 months' corrected age.
Patients And Methods: Surviving infants were evaluated with standardized neurologic examination and Bayley Scales of Infant Development-II. Neurodevelopmental impairment was defined as a Mental Developmental Index or Psychomotor Developmental Index of <70, cerebral palsy, blindness or deafness.
Results: A total of 252 (87%) of 291 survivors were evaluated. Cerebral palsy was diagnosed in 13% of hydrocortisone-treated versus 14% of placebo-treated infants. Fewer hydrocortisone-treated infants had a Mental Development Index <70, and more of the hydrocortisone-treated infants showed evidence of awareness of object permanence. Incidence of neurodevelopmental impairment was not different (39% [hydrocortisone] vs 44% [placebo]). There were no differences in physical growth measures. Chorioamnionitis-exposed infants treated with hydrocortisone were shorter and weighed less than controls but had no evidence of neurodevelopmental impairment. Among infants not exposed to chorioamnionitis, hydrocortisone-treated patients were less likely to have a Mental Development Index of <70 or to be receiving glucocorticoids at follow-up.
Conclusions: Early, low-dose hydrocortisone treatment was not associated with increased cerebral palsy. Treated infants had indicators of improved developmental outcome. Together with the short-term benefit previously reported, these data support additional studies of hydrocortisone treatment of adrenal insufficiency in extremely premature infants.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1542/peds.2006-3158 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Complete shielding of multivitamins to reduce toxic peroxides in the parenteral nutrition (C-SMART-PN): A randomized controlled pilot study.
Nutr Clin Pract
January 2025
Department of Nutrition, Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montréal, Québec, Canada.
Background: When exposed to ambient light, parenteral nutrition (PN) contamination with peroxides almost doubles, which increases oxidative stress in preterm infants, contributing to the development of bronchopulmonary dysplasia. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends complete PN photoprotection to reduce peroxide contamination and optimize its integrity but acknowledges the challenges of its implementation. In this study, a novel photoprotection procedure was tested for its effectiveness in reducing peroxide load and limiting ascorbic acid degradation, and for its feasibility and effectiveness in reducing urinary peroxide levels in preterm infants.
View Article and Find Full Text PDFExercise capacity and the psychosocial effect in preterm born infants - Should we do more?
Paediatr Respir Rev
January 2025
Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales 2145, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Camperdown, Sydney, New South Wales 2006, Australia.
Physical activity is crucial for children's physical, cognitive, and social development, reducing the risk of non-communicable diseases and improving overall well-being. A major legacy of extremely preterm delivery is respiratory limitation with reduced lung function and decreased exercise capacity which can be further exacerbated by inactivity and deconditioning. Strategies to increase incidental physical activities in early childhood and participation in sport and more formal exercise programmes in middle childhood have the potential to optimize cardiopulmonary function, improve quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain.
View Article and Find Full Text PDFCyclin G1 Regulates the Alveolarization in Models of Bronchopulmonary Dysplasia by Inhibiting AT2 Cell Proliferation.
Biomolecules
January 2025
Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China.
Disrupted neonatal lung alveologenesis often leads to bronchopulmonary dysplasia (BPD), the most common chronic lung disease in children. The inhibition of type 2 alveolar (AT2) cell proliferation plays an important role in the arrest of alveologenesis. However, the mechanism of AT2 cell proliferation retardation in BPD is still not fully elucidated.
View Article and Find Full Text PDFL-Citrulline in Neonates: From Bench to Bed Side.
Children (Basel)
December 2024
Division of Neonatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
L-citrulline (L-CIT), a precursor to L-arginine (L-ARG), is a key contributor to the nitric oxide (NO) signaling pathway. Endothelial dysfunction, characterized by deficient nitric oxide synthesis, is implicated in the pathogenesis of various neonatal conditions such as necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH). This review summarizes the current evidence around the possible role of L-CIT supplementation in the treatment of these conditions.
View Article and Find Full Text PDFSingle, double, and triple-hit strategies to establish a long-term premature rabbit model of bronchopulmonary dysplasia.
Respir Res
January 2025
Chiesi Farmaceutici, R&D Department, Parma, Italy.
Background: Bronchopulmonary dysplasia (BPD) is a chronic lung condition of premature neonates, yet without an established pharmacological treatment. The BPD rabbit model exposed to 95% oxygen has been used in recent years for drug testing. However, the toxicity of the strong hyperoxic hit precludes a longer-term follow-up due to high mortality after the first week of life.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!