Neonatology Department, CHRU de Tours, Tours, France.
Pediatric Neurology Department, CHRU de Tours, Tours, France.
Eur J Pediatr. 2021 Nov;180(11):3307-3315. doi: 10.1007/s00431-021-04113-z. Epub 2021 May 16.
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.
氢化可的松用于早产儿。然而，接受氢化可的松治疗的婴儿的生长速度早期出现中断。本回顾性研究旨在探讨需要接受氢化可的松治疗的极早产儿的出生后脑生长情况及其与围产期因素的关系。纳入了 2011 年至 2016 年接受氢化可的松治疗且存活至 12 个月的极早产儿。每个患儿均与 2 名未接受氢化可的松治疗且胎龄和出生头围相近的患儿相匹配。结局变量为校正胎龄至 12 个月时行 MRI 检查时的脑组织面积和出生后头围生长。进行了单变量和多变量回归分析。接受氢化可的松治疗的患儿（n=20）与未暴露于氢化可的松的 40 名患儿相匹配。接受氢化可的松治疗的患儿出生体重较低（p=0.04），机械通气时间较长（p<0.0001）。校正胎龄至 12 个月时，接受氢化可的松治疗的患儿基底节/丘脑区较小（p=0.04），头围较小（p=0.003）。然而，基底节/丘脑区和出生后脑生长与机械通气时间独立相关，与氢化可的松无关。有趣的是，观察到氢化可的松和性别之间存在显著的交互作用（p=0.04）。结论：本研究支持先前的数据，表明氢化可的松对脑生长无明显影响，并强调了极早产儿中新生儿病程严重程度与出生后脑生长的关系。已知：• 出生后接受氢化可的松治疗会暂时影响生长速度，包括头围生长。• 与地塞米松相比，出生后接受氢化可的松治疗对神经发育的影响较小。新发现：• 对于处于最严重情况的婴儿开具的氢化可的松处方对校正至 12 个月龄的脑生长没有独立影响。然而，不能排除氢化可的松根据性别产生不同影响的可能性，需要进一步探索。• 围产期因素，如出生体重和机械通气时间，是后续脑生长的决定因素。
