439 - Prophylactic Early Low-Dose Hydrocortisone (PEH) and Survival without Bronchopulmonary Dysplasia (BPD) among Extremely Premature Infants (EPI)

Poster Number: 439
Publication Number: 439.430

Sanket D. Shah, University of Florida College of Medicine, Jackonsville, FL, United States; Josef Cortez, UF Health Jacksonville, Saint Johns, FL, United States; Samarth Shukla, University of Florida College of Medicine, Jacksonville, FL, United States; P. Sireesha Nandula, University of Florida College of Medicine, Jacksonville, FL, United States; Mark L. Hudak, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States

Background: Although the incidences of many morbidities experienced by EPI (gestational age GA < 28 weeks) have declined, similar progress for BPD has remained elusive. BPD is an independent risk factor for death and abnormal neurodevelopment. Neonatologists have used various treatment regimens of potent corticosteroids to prevent or palliate BPD, but no regimen has consistently improved survival without BPD. Further, postnatal treatment with corticosteroids has been associated with adverse outcomes (intestinal perforation, neuronal apoptosis, and poorer neurodevelopment). A recent meta-analysis by Shaffer et al1(PMID:30416014) of four published RCTs showed increased survival without BPD among EPI who received prophylactic treatment (PEH).

Objective: To compare the rates of survival without BPD between PEH and non-PEH infants.

Design/Methods: We performed a retrospective cohort analysis of EPI admitted between 01/01/2017 – 07/31/2021 to our tertiary NICU at the University of Florida Health Jacksonville. All infants treated with PEH received their first dose of hydrocortisone within 24 hours of life and a total of 10 days of treatment as follows: 0.5 mg/kg/dose twice daily for 7 days, followed by daily dose of 0.5 mg/kg for 3 days (PREMILOC regimen2(Baud et al, 2016, PMID: 26916176)). We defined BPD as an oxygen requirement at 36 weeks’ postmenstrual age and determined severity of BPD using positive pressure support and supplemental oxygen as described by Jensen et al3. We also calculated acuity score (CRIB 24) and the composite risk of death or moderate-severe BPD (NICHD5). We used Mann-Whitney U and Chi-square tests as appropriate. We employed logistic regression analysis to examine the association between PEH and survival without BPD adjusting for risk of BPD/death.

Results: Infants in the PEH group (n=77) had lower GA, lower birth weight, and higher acuity score (Table 1) so were at increased risk of BPD/death than the non-PEH group (n=209). Although unadjusted rates of survival without BPD were similar between the 2 groups, PEH treatment was associated with increased survival without BPD (OR 2.04, 95% CI 1.11–3.76, p=0.02) after adjustment for the risk of BPD/death. Of all 13 morbidities assessed (Table 2), the only significant difference in unadjusted rates was a lower rate of treatment for patent ductus arteriosus among EPI treated with PEH. For all other morbidities except one, unadjusted rates in the higher risk PEH group were equal to or less than the non-PEH group.Conclusion(s): In our cohort of EPI, early low-dose hydrocortisone treatment was safe and was associated with increased survival without BPD.
Table 1: Neonatal-Perinatal Characteristics between PEH and non-PEH groupsPEH, prophylactic early hydrocortisone; BPD, bronchopulmonary dysplasia; CRIB 2 score – Clinical Risk Index for Babies; SGA, small for gestational age
NS – p-value > 0.05

4. G. Parry et al. CRIB II: an update of the Clinical Risk Index for Babies score. Lancet 2003;361(9371):1789-91

5. Ambalavanan N, Carlo WA, Tyson JE, Langer JC, Walsh MC, Parikh NA, Das A, Van Meurs KP, Shankaran S, Stoll BJ, Higgins RD; Generic Database; Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Outcome trajectories in extremely preterm infants. Pediatrics. 2012 Jul;130(1):e115-25.
Primary and secondary outcomes between PEH and non-PEH groupsPEH, prophylactic early hydrocortisone; BPD, bronchopulmonary dysplasia; IVH; intraventricular hemorrhage; NEC, necrotizing enterocolitis; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity

3. Jensen EA, Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, Kirpalani H, Laughon MM, Poindexter BB, Duncan AF, Yoder BA, Eichenwald EC, DeMauro SB. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach. Am J Respir Crit Care Med. 2019 Sep 15;200(6):751-759. doi: 10.1164/rccm.201812-2348OC. PMID: 30995069; PMCID: PMC6775872.