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Association between Baseline Cortisol Serum Concentrations and the Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants

2020; Elsevier BV; Volume: 234; Linguagem: Inglês

10.1016/j.jpeds.2020.12.057

1097-6833

Chloe Renolleau, Artemis Toumazi, Aurélie Bourmaud, Jean‐François Benoist, Didier Chevenne, Damir Mohamed, Corinne Alberti, Valérie Biran, Olivier Baud, Valérie Biran, Caroline Farnoux, Sophie Soudée, L. Maury, Michèle Granier, Florence Lebail, Duksha Ramful, Sylvain Sampériz, Alain Beuchée, Karine Guimard, Fatima El Moussawi, Pascal Boileau, Florence Castela, C. Nicaise, Renaud Vialet, P Andrini, Thierry Debillon, V. Zupan-Simunek, H. Razafimahefa, Anne Coursol, S. Merbouche, Pascal Bolot, J. Kaňa, Julie Guichoux, Olivier Brissaud, Gérard Thiriez, Olivier Schulze, Mickael Pomedio, P Morville, Thierry Blanc, Stéphane Marret, B. Guillois, Cénéric Alexandre, Stéphane Le Bouëdec, B. Leboucher, Umberto Siméoni, V. Lacroze, Pierre Kuhn, Stéphanie Litzler-Renaud, Elodie Zana‐Taïeb, Pierre‐Henri Jarreau, Sylvain Renolleau, Virginie Meau‐Petit, Gilles Cambonie, Aline Rideau Batista‐Novais,

Infant Development and Preterm Care

To define nomograms of serum cortisol values before 24 hours of postnatal life for extremely preterm infants and determine whether baseline cortisol values affect the benefit/risk ratio of prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia (BPD).We performed a predefined secondary analysis of the multicenter randomized controlled PREMILOC trial that included inborn infants delivered before 28 weeks of gestation. Nomograms of baseline serum cortisol values measured in 325 enrolled patients were determined for male and female neonates and correlated to perinatal events. BPD-free survival and severe adverse events were analyzed in placebo and hydrocortisone groups according to the cortisol z score in multivariate logistic regression models.Increased cortisol levels measured before 24 hours following birth were associated with a significantly higher chance of BPD-free survival only in placebo-treated infants (aOR [95% CI] 1.57 [1.08-2.27], P = .02) based on sex-specific nomograms for baseline cortisol levels. The cortisol z score for infants treated with prophylactic hydrocortisone predicted a risk of high-grade intraventricular hemorrhage (aOR [95% CI] 1.82 [1.06-3.15], P = .03) and spontaneous intestinal perforation (aOR [95% CI] 4.81 [1.34-17.22], P = .02).We found no predictive value of baseline cortisol levels for BPD-free survival in infants born extremely preterm treated with hydrocortisone. However, high cortisol levels early after birth were associated with a greater risk of severe intraventricular hemorrhage and spontaneous intestinal perforation in infants treated with hydrocortisone and, therefore, a lower benefit/risk ratio for the treatment.EudraCT 2007-002041-20, ClinicalTrial.gov: NCT00623740.