722 - Impact of Steroid Type, Timing, and Cumulative Exposure on Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants

Publication Number: 1699.722

Amrita D. Balram, Virginia Commonwealth University School of Medicine, Henrico, VA, United States; Dara Azuma, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Nayef Chahin, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Allison Williams, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Jie Xu, Virginia Commonwealth University, Richmond, VA, United States; Karen D.. Hendricks-Muñoz, Children's Hospital of Richmond at VCU, Richmond, VA, United States

Background: Steroids reduce inflammation and aid respiratory function in preterm infants. However, their use has been associated with neurological alterations including brain growth impairment. This study sought to characterize the influence of steroid type, timing, and duration of exposure on long-term neurodevelopmental impairment to provide guidance for safer, more effective steroid use in neonatal care.

Objective: To determine the impact of steroid type, timing, and duration of exposure on neurodevelopmental outcomes in the extremely low birth weight infant (ELBW).

Design/Methods: Retrospective study of ELBW infants born at Children's Hospital of Richmond at VCU between 2014-2023. Type , timing, and duration of steroid-treated and non-treated groups were identified. Infant and maternal characteristics were evaluated, with Bayley Scales of Infant development III at 12 and 24 months used to assess neurodevelopmental outcomes. Statistical analysis was performed using student's t-test, chi square and linear regression where appropriate. Significance was set at p < 0.05.

Results: We identified 128 infants of which 84 (66%) received steroids and 44 (34%) did not. Mean motor scores at 12 months corrected age were significantly lower in the steroid exposed versus the non-steroid exposed group (85.2 vs.95.2, p=0.01). Mean cognitive scores at 12 months corrected age were also lower in the steroid exposed group versus the non-steroid exposed group (89.2 vs 99.8, p=0.005). Differences resolved by 24 months of age and there was no difference in language scores at 12 or 24 months. There was no difference in neurodevelopmental outcomes between type of steroid exposure which included hydrocortisone, dexamethasone, and methylprednisolone/prednisolone. Additionally, early exposure, within first 30 days of life, had no effect on neurodevelopmental outcomes as compared to late steroid exposure, after first 30 days of life. Duration of steroid exposure correlated with a decline in 12-month language scores, that resolved by 24 months, when adjusting for gestational age, birth weight, sex, and antenatal steroid exposure.

Conclusion(s): Steroid exposure was associated with transient delays in language and cognitive development, and duration of steroid exposure was associated with reduced language scores at 12 months corrected age. These impairments resolved by 24 months. The findings highlight the safety of cautious use of steroids and warrant further research into long-term effects on language and executive function in the ELBW infant.

Figure 1. Impact of Cumulative Exposure on Neurodevelopmental Outcomes
For cumulative exposure, there was decline at 12-months corrected age in language scores, that did not persist at 24 months corrected age.

Figure 2. Bayley Neurodevelopmental Outcomes by Steroid Exposure
At 12 months corrected age, mean motor outcomes and mean cognitive outcomes were significantly lower in the steroid exposed group versus the non-steroid exposed group. These differences resolved by 24 months of age. There was no effect of steroids on long term neurodevelopmental outcomes at 24 months for language, cognition, and motor function.

Figure 3. Demographics of steroid exposed versus non-steroid exposed group
The steroid group were of significantly lower gestational age (25.16 vs. 26.58 weeks) (p <0.001), experienced longer ventilation duration (77.27 vs.12.70 days) (p < 0.001), had extended NICU stays (153.87 vs. 91.50 days) (p <0.001), and a had higher proportion of males (54%) (p =0.027).