Abstract
Introduction: Animal studies have shown that corticosteroids (dexamethasone) cause neuronal loss in the hippocampus and deficits in short term memory. Proton magnetic resonance spectroscopy measures brain metabolites in vivo and gives an indication of neuronal integrity.
Aim of the study: To investigate whether prolonged administration of hydrocortisone during the neonatal period for bronchopulmonary dysplasia (BPD) in preterm born children changes the metabolism in the hippocampus measured at school age. Secondly, to investigate whether hippocampal metabolism and short-term memory and neurodevelopmental outcome are related.
Patients and methods: 37 Preterm born children (< 32 weeks (range 25.0–33.0) and/or a birth weight <1500 grams) underwent proton spectroscopy of the hippocampus at school age. 18 Children were treated with hydrocortisone for BPD (starting dose 5 mg/kg/d tapered over a minimum period of 22 days, median duration 28 days) and 19 never received corticosteroids. N-acetyl aspartate/ Choline + (phospho)Creatine (NAA/(Cho+Cr)) ratios were determined. A 15 words recall memory test and IQ measurement were obtained on the same day.
Results: Hydrocortisone treated children were younger (27.9 vs 30.6 weeks, p<0.0001), lighter (1091 vs 1379 grams, p=0.017) and sicker (artificial ventilation 100% vs 68%, p=0.02, need for inotropes 44% vs 16%, p=0.057) than their nonsteroid treated counterparts. Mean NAA/(Cho+Cr) ratios in the hippocampus were not significantly different in the hydrocortisone group compared with the nonsteroid group (0.67 vs 0.63, p=0.20). Performance on the 15 words memory test (6.61 vs 6.21, p=0.57) and IQ (97 vs 95, p=0.67) were similar in the two groups. There was no relation between NAA/(Cho+Cr) ratios and memory nor between NAA/(Cho+Cr) ratios and IQ.
Conclusion: Hydrocortisone administered in the neonatal period for BPD does not change metabolism of the hippocampus as measured by proton MR spectroscopy nor outcome as tested by short-term memory and IQ. Hydrocortisone used in the mentioned dose appears safe for preterm neonates with BPD.
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Rademaker, K., Rijpert, M., Uiterwaal, C. et al. 300 Neonatal Hydrocortisone Treatment Related to 1H-Mrs of the Hippocampus and Short-Term Memory at School Age in Preterm Born Children.. Pediatr Res 58, 406 (2005). https://doi.org/10.1203/00006450-200508000-00329
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DOI: https://doi.org/10.1203/00006450-200508000-00329