Hydrocortisone for BPD: No effect on brain growth

There’s good news for premature infants with bronchopulmonary dysplasia (BPD): treatment with hydrocortisone does not seem to adversely effect brain growth, meaning that it may provide a safer alternative to dexamethasone.

Bronchopulmonary dysplasia is a form of chronic lung disease that frequently develops in preterm neonates treated with oxygen and positive-pressure ventilation. Many of the infants who develop the condition are born earlier than at 30 weeks’ gestation and weigh less than 2 pounds. In fact, previous studies indicate that about half of all infants weighing less than 1,250 g at birth develop BPD.

Although dexamethasone has been the treatment of choice, concern has arisen recently surrounding whether dexamethasone increases the risk of adverse neurodevelopmental outcomes, particularly in the long-term.

In this latest study conducted in the Netherlands, researchers looked at 146 infants with BPD, half of whom were treated with hydrocortisone and half of whom were not. All the infants underwent magnetic resonance imaging at term-equivalent age. The researchers excluded any with overt parenchymal pathology.

The mean gestational age of the infants was 26.7 weeks and their mean birth weight was 906 g. After controlling for gestational age, postmenstrual age at time of scanning, the presence of intraventribular hemorrhage, and birth weight z-score, the researchers found no differences between the groups in either total brain tissue or in cerebellar volumes.

The investigators noted that a randomized, controlled trial looking at long-term neurodevelopmental outcomes is needed before firm conclusions can be drawn.