#183 - [Journal Club Shorts] - π Hydrocortisone in very preterm neonates for BPD prevention: meta-analysis and effect size modifiers.
Feb 11, 2024
07:54
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De Luca D, Ferraioli S, Watterberg KL, Baud O, Gualano MR discuss their meta-analysis on hydrocortisone use in very preterm neonates for BPD prevention. Hydrocortisone didn't reduce BPD, but reduced mortality and showed potential benefits on secondary outcomes. They also explore challenges and factors in treating babies with Corio, emphasizing the impact of inflammation on at-risk children.
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Quick takeaways
Hydrocortisone did not reduce bronchopulmonary dysplasia, but showed benefits in reducing mortality and necrotizing enterocolitis.
The effectiveness of hydrocortisone in reducing BPD varied based on treatment duration and neonatal chorioamnionitis, suggesting a case-by-case consideration for secondary outcomes.
Deep dives
Hydrocorrhizone does not reduce BPD, but has benefits on secondary outcomes
This meta-analysis of seven trials involving over 2,000 neonates found that hydrocorrhizone did not reduce bronchopulmonary dysplasia (BPD). However, the analysis revealed several secondary outcomes in which hydrocorrhizone showed benefits. It significantly reduced mortality and necrotizing enterocolitis (NEC). The effectiveness of hydrocorrhizone in reducing BPD was inversely associated with the duration of treatment, with a 10 to 12-day duration yielding better results. Neonates with chorioamnionitis showed greater response to hydrocorrhizone. These findings suggest that hydrocorrhizone could be considered on a case-by-case basis for certain secondary outcomes.
Inconclusive impact of hydrocorrhizone on IVH and PVL
The meta-analysis also investigated the impact of hydrocorrhizone on intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). While the results for IVH were not significant, there was a trend favoring the control group. However, for PVL, the hydrocorrhizone group showed a slight favorability, although it did not reach significance. The analysis did not analyze certain respiratory factors, such as duration of oxygen support or ventilation, due to insufficient data. Future trials should explore potential effect size modifiers and further examine the impact of hydrocorrhizone on IVH and PVL.
1.
Exploring the Use of Hydrocortisone in Very Preterm Neonates for BPD Prevention: Meta-Analysis and Effect Size Modifiers
De Luca D, Ferraioli S, Watterberg KL, Baud O, Gualano MR.Arch Dis Child Fetal Neonatal Ed. 2024 Jan 17:fetalneonatal-2023-326254. doi: 10.1136/archdischild-2023-326254. Online ahead of print.PMID: 38237961
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.
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