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Hydrocortisone may spare head growth, but the debate for steroid use rages on

Pediatric Research volume 94, pages 1867–1869 (2023)Cite this article

The appropriate formulation, dosing, timing, and duration of corticosteroid administration in extremely preterm infants remains a mystery. High dose dexamethasone was initially used in attempts to expedite extubation in the 1990s, but popularity quickly decreased when concerns arose for worsening cognitive and neurodevelopmental impairments in those exposed to the steroid.1,2,3 Thus, lower dose dexamethasone and hydrocortisone have since become more favored treatment options.

Chen et al. add a new finding to the debate over use of corticosteroids in extremely preterm infants in this issue of Pediatric Research. The authors note that while their population overall showed impairment of growth over their NICU course, hydrocortisone therapy was associated with preservation of head growth when adjusted for illness severity. Onland et al. noted in their randomized trial that infants receiving hydrocortisone had a higher weight at 36 weeks postmenstrual age,4 although head circumference and length were similar. Studies have often focused on the impact of hydrocortisone on mortality and morbidities, and many have shown early, low-dose hydrocortisone increased the rate of survival without bronchopulmonary dysplasia.5,6 However, studies of later hydrocortisone therapy found no difference in survival without moderate or severe bronchopulmonary dysplasia.4,7

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Acknowledgements

The authors would like to acknowledge the following individuals from the Pediatric Policy Council for their thoughtful review of the commentary: Shetal Shah, MD, Chair, Pediatric Policy Council; Mona Patel, MD, Academic Pediatric Association Representative; Maya Ragavan, MD, MPH, MS, Academic Pediatric Association Representative; David Keller, MD, American Pediatric Society Representative; Lisa Chamberlain, MD, MPH, American Pediatric Society Representative; Tina Cheng, MD, MPH, Association of Medical School Pediatric Department Chairs Representative; Ann Reed, MD, Association of Medical School Pediatric Department Chairs Representative; Joyce Javier, MD, MPH, MS, Society for Pediatric Research Representative; Lois Lee, MD, MPH, Society for Pediatric Research Representative.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Hellen Ko & Jessie R. Maxwell

  2. Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA

    Ashwini Lakshmanan

  3. Department of Neurosciences, University of New Mexico Health Science Center, Albuquerque, NM, USA

    Jessie R. Maxwell

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  1. Hellen Ko
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Contributions

H.K.: Substantial contributions to review of the literature; Drafting and revising the manuscript critically for important intellectual content; Final approval of the version for publication. A.L.: Substantial contributions drafting and revising the manuscript critically for important intellectual content; Final approval of the version for publication. J.R.M.: Substantial contributions to review of the literature; Drafting and revising the manuscript critically for important intellectual content; Final approval of the version for publication.

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Correspondence to Jessie R. Maxwell.

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Article: Interaction of hydrocortisone and illness severity on head growth in cohort of ELBW infants.

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Ko, H., Lakshmanan, A. & Maxwell, J.R. Hydrocortisone may spare head growth, but the debate for steroid use rages on. Pediatr Res 94, 1867–1869 (2023). https://doi.org/10.1038/s41390-023-02845-2

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