title: Pretreatment cortisol values may predict responses to hydrocortisone administration for the prevention of bronchopulmonary dysplasia in high-risk infants.
abstract: OBJECTIVE
  To investigate the effect of hydrocortisone treatment on survival without bronchopulmonary dysplasia (BPD) and to study whether serum cortisol concentrations predict the response.
  
  
  METHODS
  We performed a randomized, placebo-controlled trial on infants with gestation < or =30 weeks, body weight of 501 to 1250 g, and respiratory failure. Hydrocortisone was started before 36 hours of age and given for 10 days at doses from 2.0 to 0.75 mg/kg per day. Shortly before hydrocortisone treatment, basal and stimulated (ACTH, 0.1 microg/kg) serum cortisols were measured.
  
  
  RESULTS
  The study was discontinued early, because of gastrointestinal perforations in the hydrocortisone group (4/25 vs 0/26, P = .05); 3 of the 4 had received indomethacin/ibuprofen. The incidence of BPD (28% vs placebo 42%, P = 0.28) tended to be lower, and patent ductus arteriosus (36% vs 73%, P = .01) was lower in the hydrocortisone group. The hydrocortisone-treated infants with serum cortisol concentrations above the median had a high risk of gastrointestinal perforation. In infants with cortisol values below the median, hydrocortisone treatment increased survival without BPD.
  
  
  CONCLUSIONS
  Serum cortisol concentrations measured shortly after birth may identify those very high-risk infants who may benefit from hydrocortisone supplementation.
authors.affiliation: Department of Pediatrics, Biocenter Oulu, University of Oulu, PO Box 5000, FIN-90014 Oulu, Finland,
authors.forename: Outi
authors.initials: O
authors.lastname: Peltoniemi
authors.forename: M Anneli
authors.initials: MA
authors.lastname: Kari
authors.forename: Kirsti
authors.initials: K
authors.lastname: Heinonen
authors.forename: Timo
authors.initials: T
authors.lastname: Saarela
authors.forename: Kari
authors.initials: K
authors.lastname: Nikolajev
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.forename: Raimo
authors.initials: R
authors.lastname: Voutilainen
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D005260:Female; D005387:Finland; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use*; D007226:Infant Mortality; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000139:chemically induced; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone