Patent Ductus Arteriosus, Hydrocortisone, and Outcome among Infants Born Extremely Preterm: Secondary Analysis of the Hydrocortisone Trial

Abstract

Objective

To examine whether hydrocortisone (HC) modified the relationship of patent ductus arteriosus (PDA) to outcomes among infants born extremely preterm and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network (NRN) HC trial.

Study design

This was a posthoc secondary analysis of infants born <30 weeks’ gestation and enrolled in the NRN HC Trial. The primary outcome was moderate to severe bronchopulmonary dysplasia (BPD) or death. Secondary outcomes included moderate to severe BPD, death, necrotizing enterocolitis, late-onset sepsis, days of mechanical ventilation, oxygen supplementation, Z-scores for growth, home oxygen, BPD severity, neurodevelopmental impairment, and moderate to severe cerebral palsy. Analyses for interaction between PDA (defined as treatment to achieve PDA closure) and HC were performed for the primary and secondary outcomes.

Results

Of 800 infants enrolled in the NRN HC trial, PDA was treated in 198 HC treated and 197 placebo-treated infants. HC did not modify the relationship of PDA with BPD or death (P = .93). Regardless of HC treatment, PDA was associated with a significant increase in duration of ventilatory support, oxygen supplementation at 36 weeks postmenstrual age (PMA), BPD severity, decreased weight-for-age Z-score at 36 weeks PMA, moderate to severe BPD, or death at 36 weeks PMA and home oxygen support.

Conclusions

HC after the second postnatal week did not alter the relationship between PDA and BPD or death among infants born extremely preterm. PDA was associated with several adverse outcomes regardless of HC treatment.