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Duration of mechanical ventilation is more critical for brain growth than postnatal hydrocortisone in extremely preterm infants

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Abstract

Hydrocortisone is used in preterm infants. However, early disruption of growth velocities was observed in infants exposed to hydrocortisone. This retrospective study aimed to explore the postnatal brain growth of extremely preterm infants requiring hydrocortisone treatment as well as its association with perinatal factors. Extremely preterm infants exposed to hydrocortisone from 2011 to 2016 who survived up to 12 months were included. Each of them was matched with two infants not treated with hydrocortisone exhibiting similar gestational ages and nearly similar birth head circumferences. The outcome variables were brain tissue areas on MRIs performed at term-equivalent age and postnatal head circumference growth up to a corrected age of 12 months. Univariate and multiple regression analyses were performed. Infants treated with hydrocortisone (n=20) were matched with 40 infants not exposed to hydrocortisone. The infants exposed to hydrocortisone exhibited a lower birth weight (p=0.04) and a longer duration of mechanical ventilation (p<0.0001). Infants treated with hydrocortisone exhibited a smaller basal ganglia/thalamus area (p=0.04) at term-equivalent age and a smaller head circumference at a corrected age of 12 months (p=0.003). However, the basal ganglia/thalamus area and the postnatal brain growth were independently associated with the duration of mechanical ventilation and not with hydrocortisone. Interestingly, a significant interaction between hydrocortisone and sex was observed (p=0.04).

Conclusion: This study supports previous data that indicated no obvious impact of hydrocortisone on brain growth and highlights the relationship between the severity of the neonatal course and postnatal brain growth in extremely preterm infants.

What is Known:

• Postnatal hydrocortisone disrupts transiently growth velocities including the head circumference growth.

• Postnatal hydrocortisone has less impact on neurodevelopment than dexamethasone.

What is New:

• Hydrocortisone prescribed for infants in the most severe conditions did not show independent effect on brain growth up to the corrected age of 12 months. However, a different effect of hydrocortisone according to sex can't be excluded and needs further explorations.

• Perinatal factors as birth weight and duration of mechanical ventilation were determinant for the subsequent brain growth.

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Abbreviations

BGT:

Basal ganglia and thalamus

BPD:

Bronchopulmonary dysplasia

FiO2 :

Fraction of inspired oxygen

HC:

Head circumference

MRI:

Magnetic resonance imaging

TEA:

Term-equivalent age

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Author information

Authors and Affiliations

  1. Neonatology Department, CHRU de Tours, Tours, France

    Chloé Rousseau, Elie Saliba & Geraldine Favrais

  2. Pediatric Neurology Department, CHRU de Tours, Tours, France

    Marine Guichard

  3. UMR 1253, iBrain, Université de Tours, INSERM, Tours, France

    Elie Saliba, Baptiste Morel & Geraldine Favrais

  4. Pediatric Radiology Department, CHRU de Tours, Tours, France

    Baptiste Morel

  5. Service de Néonatologie-Hôpital Bretonneau, CHRU de Tours, 2, Boulevard Tonnellé, 37044, Tours Cedex 9, France

    Geraldine Favrais

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  1. Chloé Rousseau
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  2. Marine Guichard
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  4. Baptiste Morel
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  5. Geraldine Favrais
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Contributions

CR and MG collected the data and performed the data analysis. ES contributed to the critical reading of the manuscript. BM performed the MRI segmentation and analysis and helped write and critically read the manuscript. GF designed the study protocol, obtained ethics approval, performed the final data analysis, and wrote the manuscript.

Corresponding author

Correspondence to Geraldine Favrais.

Ethics declarations

Ethics approval

The local ethics committee (2017-031) and local data protection authority (2017-07) approved the protocol for this study.

Consent to participate and for publication

Oral and written information was provided to parents or authorized guardians. They could refuse the exploitation of their child’s data by expressing their opposition.

Competing interests

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Rousseau, C., Guichard, M., Saliba, E. et al. Duration of mechanical ventilation is more critical for brain growth than postnatal hydrocortisone in extremely preterm infants. Eur J Pediatr 180, 3307–3315 (2021). https://doi.org/10.1007/s00431-021-04113-z

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