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The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn

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Abstract

Objective

Characterize association between hydrocortisone receipt and hospital outcomes of infants with persistent pulmonary hypertension of the newborn (PPHN).

Study design

Cohort study of infants ≥34 weeks with PPHN who received inhaled nitric oxide at <7 days of age (2010–2016). We generated propensity scores, and performed inverse probability-weighted regression to estimate hydrocortisone effect on outcomes: death, chronic lung disease (CLD), oxygen at discharge.

Results

Of 2743 infants, 30% received hydrocortisone, which was associated with exposure to mechanical ventilation, sedatives, paralytics, or vasopressors (p < 0.001). There was no difference in death, CLD, or oxygen at discharge. In infants with meconium aspiration syndrome, hydrocortisone was associated with decreased oxygen at discharge (odds ratio 0.56; 95% confidence interval 0.21, 0.91).

Conclusions

There was no association between hydrocortisone receipt and death, CLD, or oxygen at discharge in our cohort. Prospective studies are needed to evaluate the effectiveness of hydrocortisone in infants with PPHN.

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Fig. 1: Percentage of infants with PPHN receiving hydrocortisone, by year.

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Funding

This work was supported by Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program (grant #5R25HD076475-07). This work was partially funded under the National Institute of Child Health and Human Development (NICHD) contract (HHSN275201000003I) for the Pediatric Trials Network (PI Danny Benjamin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Duke University, Durham, NC, USA

    Samia Aleem, Kanecia O. Zimmerman, Ronald N. Goldberg & Rachel G. Greenberg

  2. Duke Clinical Research Institute, Durham, NC, USA

    Cliff Robbins, Brianna Murphy, Stephen Elliott, Christiana Akinyemi, Nicholas Paredes, Kanecia O. Zimmerman & Rachel G. Greenberg

  3. Department of Neonatology, Baylor University Medical Center, Dallas, TX, USA

    Veeral N. Tolia

  4. Pediatrix Medical Group, Dallas, TX, USA

    Veeral N. Tolia

  5. Department of Economics, Clemson University, Clemson, SC, USA

    Daniel K. Benjamin

Authors
  1. Samia Aleem
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  2. Cliff Robbins
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  3. Brianna Murphy
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  4. Stephen Elliott
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  5. Christiana Akinyemi
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Contributions

SA is the guarantor who accepts full responsibility for the work and conduct of the study, and had access to the data. SA conceptualized and designed the study, and contributed to the data interpretation, the drafting of the initial paper, and reviewing and revising the paper. CR contributed to the data interpretation and the paper drafting. BM contributed to the data interpretation and the paper drafting. SE contributed to the data interpretation and the paper drafting. CA contributed to the data interpretation and the paper drafting. NP contributed to the data interpretation and the paper drafting. DKB contributed to the study design, data analyses, and the critical revision of the paper for important intellectual content. VNT contributed to the data interpretation and the critical revision of the paper for important intellectual content. KOZ contributed to the data interpretation and the critical revision of the paper for important intellectual content. RNG contributed to the data interpretation and the critical revision of the paper for important intellectual content. RGG contributed to the conception and design of the study, supervised the drafting of the paper, interpreted the data analyses, and reviewed and revised the paper. RGG had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Rachel G. Greenberg.

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Conflict of interest

RGG has received support from industry for research services (https://dcri.org/about-us/conflict-of-interest/). The other authors have no competing interests relevant to this article to disclose.

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Aleem, S., Robbins, C., Murphy, B. et al. The use of supplemental hydrocortisone in the management of persistent pulmonary hypertension of the newborn. J Perinatol 41, 794–800 (2021). https://doi.org/10.1038/s41372-021-00943-9

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