71 - Cumulative Hydrocortisone Exposure and Early Brain Volumetrics in Very Low Birth Weight Infants: Associations with Neurodevelopmental outcomes

Publication Number: 1064.71

SaeYun Kim, The catholic university of Korea, Seoul s' Mary's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Min Soo Kim, Seoul saint Mary’s hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Moon-yeon Oh, Catholic University of Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Jeongmin Shin, Seoul St. Mary Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Young-Ah Youn, Seoul St. Mary's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Soo-Ah Im, Seoul St.Mary's hospital, College of Medicine, The catholic university of Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: Systemic hydrocortisone (HCS) in very low birth weight (VLBW) infants are commonly used to treat early hypotension or prevent bronchopulmonary dys-plasia.

Objective: This study evaluated the associations between postnatal HCS exposure and neu-rodevelopment in VLBW infants by comparing regional brain volume at term-equivalent age (TEA) with neurodevelopmental outcomes in early infancy.

Design/Methods: This was a retrospective cohort study. VLBW infants with a GA of ≤ 32+6 weeks, who were born between 2013 and 2019, and admitted to the neonatal intensive care unit (NICU) of Seoul St. Mary's Hospital were eligible. The cumulative HCS dose during hospitalization was recorded, and regional brain volumes were analyzed using magnetic resonance imaging at TEA. Neurodevelopmental outcomes were assessed at corrected age for prematurity 18-24 months.

Results: Among 146 infants, 57 were classified in the high HCS group (>90 mg/kg) and 89 in the low HCS group (≤90 mg/kg HCS). Infants in the high HCS group had significantly lower GA (27.2 ± 2.0 weeks vs. 28.6 ± 2.1 weeks, P < 0.001) and birth weight (917.7 ± 248.9 g vs. 1133.7 ± 220.9 g, P < 0.001) than those in the low HCS group.
Bronchopulmonary dysplasia, periventricular leukomalacia, and sepsis were more frequent in the high HCS group. Ninety-five infants underwent magnetic resonance imaging; infants in the high HCS group exhibited reduced intracranial volume (309.7 ± 57.5 cm3 vs. 371.2 ± 66.1 cm3, P < 0.001), cerebellar volume (13.8 ± 5.8 cm3 vs. 19.6 ± 5.9 cm3, P < 0.001), and cerebral volume (292.5 ± 52.5 cm3 vs. 346.4 ± 61.8 cm³, P < 0.001) than those in the low HCS group. Brainstem volume was also significantly lower in the high HCS group (4.4 ± 0.8 cm³ vs. 5.3 ± 0.8 cm³, P < 0.001).
At follow-up, cerebral palsy (35.9% vs. 9.1%, P=0.003) neurodevelopmental impairment (54.0% vs. 23.6%, P=0.002), and head circumference < 10th percentile (64.3% vs. 19.5%, P< 0.001) were more common in the high HCS group. After adjustment, HCS >90 mg/kg remained independently associated with cerebral palsy (adjusted odds ratio [aOR] 5.44, P=0.016) and reduced head circumference (aOR 4.45, P=0.016).

Conclusion(s):

Conclusions: High cumulative HCS exposure correlated with reduced brain volume at TEA and adverse neurodevelopmental outcomes at 24 months of age. Careful monitoring of dose and treatment duration is essential to balance therapeutic benefits against potential risks.

Acknowledgement: This study was supported by Research Fund of Seoul St. Mary's Hospital, The Catholic University of Korea (No. KC24RISI0775 to S.Y.K.).

ROC curves for cerebral palsy prediction across cumulative hydrocortisone dose thresholds
ROC curves are shown for dose cutoffs of>40, >57.5, >70, >90, >100, and >120 mg/kg. The corre-sponding AUCs were 0.630, 0.661, 0.648, 0.702, 0.689, and 0.669, respectively. The >90 mg/kg cut-off was selected as the optimal threshold using the "largest AUC" criterion (i.e., the cutoff yielding the maximum AUC among candidates). Abbreviations: AUC, area under the curve; HCS, hydrocortisone; CP, cerebral palsy; ROC, receiver operating characteristics.

Multiple logistic regression analysis model between cumulative hydrocortisone dose and long-term outcomes
aORs were adjusted for variables significantly associated with neonatal outcomes in the univariate analysis. CP is defined as a GMFCS level ≥II. NDI is defined as the composite of any Bayley-III subdomain score < 85 or CP. A total of 94 infants completed the evaluation for CPa, 118 infants completed the evaluation for NDIb, and 69 infants completed head circumference meas-urementc at 18-24 months of corrected age.
Abbreviations: aOR, adjusted odds ratio; Bayley-III, Bayley Scales of Infant and Toddler Devel-opment-III; CI, confidence interval; CP, cerebral palsy; GMFCS, Gross Motor Function Classifi-cation System; HC, head circumference; HCS, hydrocortisone; NDI, neurodevelopmental impairment.

Brain volume depending on the cumulative dose of hydrocortisone
Values are expressed as mean ± SD.
Abbreviations: HCS, hydrocortisone;