472 - Systemic hydrocortisone exposure modulates the effects of illness severity on head growth in ELBW infants during NICU hospitalization

Poster Number: 472
Publication Number: 472.342

Haiwen Chen, Johns Hopkins Children's Center, Baltimore, MD, United States; Khyzer Aziz, Johns Hopkins Children's Center, Baltimore, MD, United States; Austin Sellers, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Harisa Spahic, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Sandra Brooks, Johns Hopkins All Children’s Hospital, St Petersburg, FL, United States; Sarah Miller, Johns hopkins school of medicine, Baltimore, MD, United States; Allen Everett, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Frances Northington, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Carl E. Stafstrom, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Raul Chavez-Valdez, Johns Hopkins Children's Center, Catosnville, MD, United States

Background: Extremely low birth weight (ELBW) premature infants comprise a fragile population at risk for neurodevelopmental disabilities (NDD). Use of systemic steroids, specifically dexamethasone, has been previously associated with NDD and cerebral palsy in preterm infants. More recent studies suggest hydrocortisone (HCT) may improve survival without increasing NDD. To date, there are no studies that assess the effect of HCT on head growth adjusted for severity of illness during NICU hospitalization.

Objective: To evaluate whether postnatal systemic HCT exposure in ELBW infants protects head growth during hospitalization while adjusting for severity of illness.

Design/Methods: Prospective data from the Adult Biomarkers in Neonatal Brain Injury and Development study was combined with retrospective data on anthropometric measurements, medications, and variables needed for calculation of the neonatal Sequential Organ Failure Assessment (nSOFA) score during initial NICU admission. We included 106 infants born at 23-29 weeks gestational age (GA) and < 1000g admitted to the Johns Hopkins Hospital (JHH) NICU from 2016-2019. Exclusion criteria included: i) diagnosis of ventriculomegaly, hydrocephalus, or stroke, ii) less than 3 total occipitofrontal head circumference (OFC) measurements, and iii) use of a steroid other than HCT. To account for effects of GA and sex of the patients, OFC measurements were normalized to Fenton growth curves to generate OFC z-scores. We then calculated the area under the curve (AUC) of OFC z-scores during the time of hospitalization (OFC-AUC), to control for variable lengths of stay. Illness severity was assessed using nSOFA scores, modified to exclude the steroids component (M-nSOFA), to isolate HCT effect on head growth.

Results: Included infants (Nf73) were on average 26wga and 764g at birth, and 41% received HCT. Infants exposed to HCT were born at earlier GA (mean 25wga vs. 26.8wga, p< 0.0001) but had similar normalized BW. HCT-exposed infants also had higher M-nSOFA scores (p < 0.0001), but similar OFC-AUC. While head growth (OFC-AUC) and M-nSOFA scores inversely correlated, the inclusion of HCT exposure improve the strength of these correlations. Infants exposed to HCT had better OFC-AUC compared to those who not exposed to HCT when adjusted for illness severity (F(2, 69) = 4.10, p< 0.05). In comparison weight gain, longitudinal growth and weight:length do not modulate these relationships. Conclusion(s): ELBW infants exposed to HCT may have better head growth compared to infants not exposed to HCT when controlling for illness severity during their hospitalization.
HaiwenChenCV202120210721_Chen_CV.pdf