1. Short-term pulmonary and systemic effects of hydrocortisone initiated 7-14 days after birth in ventilated very preterm infants
- Author
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Nienke M, Halbmeijer, Wes, Onland, Filip, Cools, Andre, Kroon, Marja, van der Heide-Jalving, Peter, Dijk, Henrica L M, van Straaten, Arjan B, Te Pas, Thilo, Mohns, Els, Bruneel, Arno F J, van Heijst, Boris, Kramer, Anne, Debeer, Inge A, Zonnenberg, Yoann, Marechal, Henry, Blom, Katleen, Plaskie, Maruschka P, Merkus, Martin, Offringa, Anton H, van Kaam, Elke, Dierckx, Pediatrics, RS: GROW - R4 - Reproductive and Perinatal Medicine, RS: MHeNs - R3 - Neuroscience, Kindergeneeskunde, MUMC+: MA Medische Staf Kindergeneeskunde (9), Graduate School, Paediatric Pulmonology, Amsterdam Reproduction & Development (AR&D), Neonatology, Epidemiology and Data Science, Other Research, APH - Health Behaviors & Chronic Diseases, UZB Other, Clinical sciences, Growth and Development, and SToP-BPD Study Group
- Subjects
Pulmonary and Respiratory Medicine ,LOW-DOSE DEXAMETHASONE ,MULTICENTER ,Obstetrics and Gynecology ,General Medicine ,THERAPY ,MECHANICAL VENTILATION ,DOUBLE-BLIND ,CHRONIC LUNG-DISEASE ,Pediatrics, Perinatology and Child Health ,EARLY ADRENAL INSUFFICIENCY ,Human medicine ,Pediatrics, Perinatology, and Child Health ,PREVENT BRONCHOPULMONARY DYSPLASIA ,Neonatology ,WEIGHT INFANTS ,STOP-BPD ,Respiratory Medicine - Abstract
ObjectiveObservational studies in preterm infants suggest that systemic hydrocortisone improves pulmonary condition but may also lead to systemic adverse effects. We report the short-term pulmonary and systemic effects of hydrocortisone initiated in the second week.DesignRandomised placebo-controlled trial.SettingDutch and Belgian neonatal intensive care units.PatientsInfants born InterventionInfants were randomly assigned to a 22-day course of systemic hydrocortisone (cumulative dose 72.5 mg/kg; n=182) or placebo (n=190).Main outcome measuresData on extubation, ventilator settings, glucose levels, and blood pressure were recorded daily and analysed during the first 7 days of treatment using linear mixed-effects models.ResultsInfants in the hydrocortisone group (24.3%) failed extubation less often compared with placebo (38.6%, crude risk difference: −14.3% (95% CI: −23.4% to −4.8%)). The estimated difference in daily rate of change between hydrocortisone and placebo was −0.42 cmH2O (95% CI: −0.48 to −0.36) for mean airway pressure, −0.02 (95% CI: −0.02 to −0.01) for fraction of inspired oxygen, −0.37 (95% CI: −0.44 to −0.30) for respiratory index, 0.14 mmol/L (95% CI: 0.08 to 0.21) for blood glucose levels and 0.83 mm Hg (95% CI: 0.58 to 1.09) for mean blood pressure.ConclusionsSystemic hydrocortisone initiated between 7 and 14 days after birth in ventilated preterm infants improves pulmonary condition, thereby facilitating weaning and extubation from invasive ventilation. The effects of hydrocortisone on blood glucose levels and blood pressure were mild and of limited clinical relevance.Trial registration numberNetherlands Trial Register (NTR2768;https://www.trialregister.nl/trial/2640) and European Union Clinical Trials Register (EudraCT, 2010-023777-19).
- Published
- 2022