Preemies get no benefit from steroid treatment
Washington, Oct 10 : A new study at Johns Hopkins Children's Center has raised
questions against the age-old practice of treating premature babies with hydrocortisone, a
steroid considered to fight inflammation and prevent lung disease.
Researchers claimed that such treatment doesn't offer much benefit and also low
cortisol levels are not even necessarily harmful.
On the other hand, high cortisol levels, apparently increase the risk of dangerous
bleeding in the brain and it is required that babies should be monitored aggressively to
ward off life-threatening complications.
Premature babies and adults having a condition, called relative adrenal insufficiency,
have abnormally low levels of the stress hormone cortisol and it is usually treated by
hydrocortisone therapy in the newborns.
The new findings, however, shed new light on the clinical meaning of low cortisol
levels in preemies. It shows that contrary to common belief, low blood concentrations of
this hormone do not put extremely low-birth-weight babies (those born weighing less than
2.2 pounds) at higher risk for retinopathy of prematurity - a potentially blinding eye
condition - inflammation and lung disease.
No difference was found in health outcomes between babies with low cortisol levels who
were treated with hydrocortisone and those given a placebo.
While hydrocortisone didn't have adverse effects on a baby's health, it also did
nothing to prevent or reduce respiratory diseases, infections, hemorrhages or
retinopathy.
"We were intrigued and somewhat surprised, but contrary to what we expected, low
cortisol levels do not appear to be dangerous and may actually be the norm in premature
babies. What this means is we should really think twice before rushing to treatment with
hydrocortisone in our effort to 'correct' these low levels," said study lead investigator
Susan Aucott, M.D., a neonatologist at Hopkins Children's.
It may be surprising, but the findings are not entirely counterintuitive, because in
utero babies have naturally low cortisol levels.
"This may mean that, in a way, low cortisol levels are normal, and premature babies
maintain them low, as they would have been in the womb," said Aucott.
After comparing the cortisol levels of 311 extremely low-birth-weight preemies
immediately after birth and one week after birth, researchers found low cortisol levels
did not increase the risk for adverse short-term outcomes or death.
The study was published in the latest issue of Pediatrics.
--ANI
