Replacement doses of hydrocortisone may prevent progressive chronic lung disease in extremely low birth weight infants. 1528

Kammerer, Robert; Hennessy, Amy

doi:10.1203/00006450-199704001-01547

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“…The risk of lung growth arrest appears to be greatest for the most immature infant because lung volumes are small and alveolarization is just beginning (between 24 and 28 weeks of gestation) [66]. In contrast to the high-dose dexamethasone approach, recent data on low-dose hydrocortisone (0.5 mg/kg BD) treatment in infants !1,000 g have demonstrated an increased likelihood of survival without CLD (p = 0.02, OR = 12.3, 95% CI 1.8, 151.5), particularly in infants with chorioamnionitis [89,90], suggesting an immunomodulatory benefit of this therapy. The subgroup of infants with chorioamnionitis treated with hydrocortisone also had a significantly greater enteral intake during the first 28 days of life (p = 0.01) [90].…”

Section: Adrenal Immaturity Postnatal Dexamethasone Necrotizing Entmentioning

confidence: 99%

Hormonal Factors in the Morbidities Associated with Extreme Prematurity and the Potential Benefits of Hormonal Supplement

Yeung

Smyth²

2002

Neonatology

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Cortisol and thyroid hormones are known to modulate the maturation of various fetal organ systems, enzymes, and biochemical pathways. The cortisol furnished by the structural and biochemical immature fetal adrenal gland renders the extremely premature infants relatively cortisol deficient in comparison with the term newborns. The premature infants also have elevated fetal androgens, the production of which persists until ≈42 weeks of postconceptional age. The androgens produced by the fetal adrenal cortex and the müllerian inhibiting substance produced by the fetal testis have antiglucocorticoid and inhibitory effects on human fetal lung growth and maturation in vitro. Hypothalamic-pituitary-thyroid axis and thyroid function are also immature in extreme prematurity. In addition, there is reduced tissue thyroid hormone responsiveness. Superimposed on this is the reduced thyroid function seen in non-thyroidal illness in which elevated cytokine levels have been implicated. Repeated courses of antenatal steroids and high-dose postnatal dexamethasone appear to be deleterious to lung and brain development. This may be through inhibition of cell replication and catabolism as well as decreased thyroid-stimulating hormone secretion and reduced peripheral conversion of T₄ to T₃. Furthermore, dexamethasone has been found to enhance neurosteroid production in the immature brain, potentially altering brain development. Considered together, the relative cortisol deficiency/androgen excess and reduced thyroid function as well as prolonged high-dose postnatal dexamethasone therapy in these infants may be important factors in their high degree of morbidity. We propose to restrict antenatal steroids to a single course and hypothesize that the overall outcome of low-gestation infants would be improved with (1) hydrocortisone (i.v./p.o.) supplement at a fixed dose of 0.5 mg/kg birth weight every 12 h in infants <30 weeks of gestation from birth till 32 weeks of postconceptional age and (2) T₃ (i.v./p.o.) supplement at a fixed dose of 0.4 µg/kg birth weight every 12 h in those <27 weeks of gestation from birth till 32 weeks of postconceptional age.

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Section: Adrenal Immaturity Postnatal Dexamethasone Necrotizing Entmentioning

confidence: 99%

Hormonal Factors in the Morbidities Associated with Extreme Prematurity and the Potential Benefits of Hormonal Supplement

Yeung

Smyth²

2002

Neonatology

View full text Add to dashboard Cite

show abstract

Replacement doses of hydrocortisone may prevent progressive chronic lung disease in extremely low birth weight infants. 1528

Cited by 1 publication

References 0 publications

Hormonal Factors in the Morbidities Associated with Extreme Prematurity and the Potential Benefits of Hormonal Supplement

Hormonal Factors in the Morbidities Associated with Extreme Prematurity and the Potential Benefits of Hormonal Supplement

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