Neurocognitive outcomes at age 5 years after prophylactic hydrocortisone in infants born extremely preterm

Aim: To assess the 5-year neurocognitive outcomes of children born extremely preterm exposed to prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia. Method: This was a prespecified secondary analysis of the PREMILOC clinical trial (trial registration: EudraCT no. 2007-002041-20, NCT00623740). The primary outcome was full-scale IQ based on the Wechsler Preschool and Primary Scale of Intelligence. Results: Among 109 surviving children recruited at the Robert Debré Children's Hospital, Paris, outcome data were available for 42 out of 56 infants (75%) in the group treated with hydrocortisone and 41 out of 53 (77%) in the placebo group. Mean scores were not significantly different between the two groups on full-scale IQ (hydrocortisone: 91.9 [SD = 13.9], placebo: 86.3 [SD = 15.4]; mean difference = 5.7, 95% confidence interval [CI] = -1.0 to 12.3, p = 0.10); however, working memory and retention ability were significantly better in the group treated with hydrocortisone. In a multivariate logistic regression including potential confounding variables, hydrocortisone treatment was significantly associated with a greater chance to survive at 5 years of age with a full-scale IQ equal to or greater than 90 compared to placebo (adjusted odds ratio = 4.26, 95% CI = 1.47-12.36, p = 0.008). Interpretation: This exploratory analysis provides reassuring data regarding the long-term neurodevelopmental safety of prophylactic hydrocortisone in infants born extremely preterm.</p

Two-year neurodevelopmental outcomes of extremely preterm infants treated with early hydrocortisone: treatment effect according to gestational age at birth

To determine whether early hydrocortisone treatment in extremely preterm infants affects neurodevelopmental outcomes at 2 years of age according to gestational age at birth

Spatial and temporal postural analysis in children born prematurely

The aim of this study was to compare postural stability in a group of preterm-born children aged 4-6 years old and in a group of age-matched full-term control children by exploring both spatial and temporal analysis of the Center of Pressure (CoP). Twenty-nine children born prematurely (mean age: 5.38±0.17) and twenty-nine age-matched full-term control children participated in this study. Postural control was tested on both a stable and an unstable platform (from Framiral®) in three different visual conditions: eyes open fixating a target, eyes closed, and with vision perturbed by optokinetic stimulation. We observed a significant increase of both surface area and mean velocity of the CoP in pre-term children compared to full-term control children, particularly in an unstable postural condition. The spectral power indices increased significantly in pre-term children with respect to full-term control children, while the cancelling time was not different between the two groups of children tested. We suggested that poor postural stability observed in preterm children could be due to immaturity of the cortical processes (the occipital parietal prefrontal cortex) involved in motor control. Preterm children could have an inappropriate compensation of sensory inputs when they are tested in difficult postural and/or visual conditions

Association Between Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years of Age

Dexamethasone to prevent bronchopulmonary dysplasia in very preterm neonates was associated with adverse neurodevelopmental events. Early low-dose hydrocortisone treatment has been reported to improve survival without bronchopulmonary dysplasia but its safety with regard to neurodevelopment remains to be assessed

Two-year neurodevelopmental outcomes of extremely preterm infants treated with early hydrocortisone: treatment effect according to gestational age at birth

International audienceOBJECTIVE :To determine whether early hydrocortisone treatment in extremely preterm infants affects neurodevelopmental outcomes at 2 years of age according to gestational age at birth.PATIENTS AND METHODS :This is an exploratory analysis of neurodevelopmental outcomes by gestational age strata from the PREMILOC trial, in which patients were randomly assigned to receive either placebo or low-dose hydrocortisone and randomisation was stratified by gestational age groups (24-25 and 26-27 weeks of gestation). Neurodevelopmental impairment (NDI) was assessed using a standardised neurological examination and the revised Brunet-Lézine scale at 22 months of corrected age.RESULTS :A total of 379 of 406 survivors were evaluated, 96/98 in the gestational age group of 24-25 weeks and 283/308 in the gestational age group of 26-27 weeks. Among surviving infants born at 24-25 weeks, significant improvement in global neurological assessment was observed in the hydrocortisone group compared with the placebo group (P=0.02) with a risk of moderate-to-severe NDI of 2% and 18%, respectively (risk difference 16 (95% CI -28% to -5%)). In contrast, no statistically significant difference between treatment groups was observed in infants born at 26-27 weeks (P=0.95) with a similar risk of moderate-to-severe NDI of 9% in both groups. The incidence of cerebral palsy or other major neurological impairments were found similar between treatment groups in each gestational group.CONCLUSIONS :In an exploratory analysis of neurodevelopmental outcomes from the PREMILOC trial, early low-dose hydrocortisone was associated with a statistically significant improvement in neurodevelopmental outcomes in infants born at 24 and 25 weeks of gestation

Postural parameters for the different conditions.

<p>Mean of Surface of the CoP (A), of length of CoP in the medio-lateral axis (B), and of mean speed of CoP (C) for the five different conditions (OKN+SVV: 40°/s left and 40°/s right, respectively, No OKN+SVV, DARK+FIX and DARK+EC) for the two groups of children tested. Verticals bars indicate the standard error. Asterisks indicate that the value is significantly different at the post-hoc test (p < 0.05).</p

Clinical characteristics of children tested.

<p>Mean and minimum and maximum values (in square brackets) of the birth weight (in gr), gestational age (in weeks), the number of boys and girls, the walking age (in months), the number of preterm children with normal MRI at 40 corrected GA and the age at assessment. p values are also shown for significant difference between the two groups of children.</p><p>Clinical characteristics of children tested.</p

Clinical test and MRI results in preterm children.

<p>Brunet Lezine’s test results: developmental quotient (DQ) for postural capability, oculomotor coordination, language and social capabilities; the global quotient is also reported. The bold values are abnormal. Writing hand left (L) or right (R) tested the day of experiment. ND test not done. Magnetic resonance imaging MRI: normal (0); abnormal (1).</p><p>Clinical test and MRI results in preterm children.</p

Mean Subjective visual vertical measure.

<p>Mean values of the SVV for the three different conditions (OKN+SVV at 40°/s toward the left and the right and the condition No OKN+SVV) for the two groups of children tested. Verticals bars indicate the standard error.</p

Mean surface area of the CoP for the preterm born children with abnormal and normal MRI results.

<p>Mean of Surface of the CoP and the standard error for the five different conditions (OKN+SVV: 40°/s left and 40°/s right, respectively, No OKN+SVV, DARK+FIX and DARK+EC) for the two groups of preterm born children tested with abnormal (10 children) and normal (9 children) MRI results.</p><p>Mean surface area of the CoP for the preterm born children with abnormal and normal MRI results.</p