Steroids Useless in Treating Preemies

Study results from the Johns Hopkins Children’s Center show treating premature babies with hydrocortisone, which is believed to fight inflammation and prevent lung disease, has very little or no benefit at all. These results were published in the October issue of Pediatrics.

Because premature babies with adrenal insufficiency tend to have very low levels of cortisol, hydrocortisone therapy has been the standard treatment for this. However, these study results challenge old beliefs, showing that low levels of cortisol do not put newborns weighing less than 2.2 pounds at high risk for retinopathy, inflammation, and lung disease, and are therefore not necessarily harmful. High cortisol levels on the other hand “appeared to increase the risk of dangerous bleeding in the brain and require that babies be monitored aggressively to ward off life-threatening complications.”

In comparing 311 very low-birth-weight premature babies at birth and one week later, researchers found that “low cortisol levels did not increase the risk for adverse short-term outcomes or death … Babies with moderately to severely elevated cortisol levels at birth and shortly after birth had a higher risk for life-threatening brain bleeds, dangerous gastrointestinal perforations and severe retinopathy, researchers found.”

There were also no differences found between premature babies given hydrocortisone, and those given a placebo. “While hydrocortisone had no adverse effects on a baby’s health, it also did nothing to prevent or reduce respiratory diseases, infections, hemorrhages, or retinopathy.” These findings challenge current common practices, but they still seem reasonable. Researchers noted that while babies are in the womb, they naturally tend to have low levels of cortisol. Therefore, it seems reasonable that premature babies would still maintain low cortisol levels as they would have in the womb.

“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,” commented lead researcher Susan Aucott, MD.

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