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  • Clinical Research Article
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Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants

Pediatric Research volume 95, pages 1028–1034 (2024)Cite this article

Abstract

Background

Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life.

Methods

Retrospective cohort study. Participants: Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle.

Results

Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract.

Conclusion(s)

Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age.

Impact

  • This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone.

  • Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways.

  • Hydrocortisone did not have a significant effect on early brain white matter circuits.

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Fig. 1
Fig. 2: White matter tractography.

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Data availability

Deidentified data will be made available upon reasonable request made to the corresponding author.

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Funding

All phases of this study were supported by the Society for Developmental Behavioral Pediatrics Research Grant to S.E.D., and by the National Institutes of Health- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.E.T., PI; 5R00HD8474904; H.M.F., PI; 2RO1- HD069150). Role of Funder/Sponsor (if any): The NIH and SDBP had no role in the design and conduct of the study.

Author information

Authors and Affiliations

  1. Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA

    Sarah E. Dubner, Lisa Bruckert, Rocío Velasco Poblaciones, Heidi M. Feldman & Katherine E. Travis

  2. Program in Human Biology, Stanford University, Stanford, CA, USA

    Lucy Rickerich & Dawson Sproul

  3. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA

    Melissa Scala

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  1. Sarah E. Dubner
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Contributions

S.E.D. conceptualized and designed the study, coordinated and supervised data collection, carried out the data analyses and interpretation, drafted the initial manuscript, and critically reviewed and revised the manuscript. L.R. collected data, performed initial data analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. D.S. collected data and critically reviewed and revised the manuscript. R.V.P. performed data analysis and critically reviewed and revised the manuscript. L.B. supervised and performed data analysis and critically reviewed and revised the manuscript. M.S. critically reviewed and revised the manuscript for important intellectual content. H.M.F. conceptualized and designed the study and critically reviewed and revised the manuscript for important intellectual content. K.E.T coordinated and supervised data collection, supervised analysis, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Katherine E. Travis.

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Dubner, S.E., Rickerich, L., Bruckert, L. et al. Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants. Pediatr Res 95, 1028–1034 (2024). https://doi.org/10.1038/s41390-023-02903-9

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