Neurodevelopmental Outcome at 20 Months Corrected Age in Extremely Preterm Infants After Exposure to Dexamethasone and Hydrocortisone in the NICU.

Abstract

Objective: To evaluate the association between hydrocortisone (HC) and dexamethasone (DEX) exposure in the NICU on neurodevelopmental (ND) outcome in extremely preterm (EPT; GA <28 weeks) infants.

Methods: This is a single-center retrospective cohort chart review of EPT infants born between 2011 to 2016 compared in terms of ND outcome at 20 months corrected age (CA). Steroid exposures, sociodemographic factors and neonatal comorbidities were collected. Outcome measures included neurologic exam and -Bayley-3 testing. Multiple regression analyses adjusted for effects of risk factors on outcome.

Results: Of the 221/264 survivors, 138 had no steroid exposure, 47 received HC only and 36 received DEX ± HC. Steroid-exposed groups were of lower birth weight and gestational age and had higher rates of neonatal comorbidities. Total duration and cumulative dosage of HC was not significantly different between steroid-exposed groups. Infants exposed to DEX ± HC had significantly lower Bayley-3 indices as compared with the no-steroid and HC only group. In linear regression analyses, DEX ± HC was associated with a 10-point reduction in cognitive (p < 0.01), language (p < 0.05), and motor (p < 0.01) indices.

Conclusions: In EPT infants, prolonged, repeated steroid exposure with DEX ± HC was associated with adverse cognitive, language and motor outcomes at 20 months CA. Further research may expose the -cumulative effect of steroids in this vulnerable population.