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Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Jodi Freeman
Abstract
Introduction: Bronchopulmonary dysplasia (BPD) is a manifestation of neonatal respiratory distress syndrome (RDS) in which a deficiency of surfactant in the lungs results in labored breathing, lung collapse, and hypoxemia. Glucocorticosteroid (GCS) administration has a critical role in the prevention and management of BPD. Prolonged GCS use has been associated with adverse effects including delayed neurodevelopmental outcomes. Currently, dexamethasone (DXM) is most commonly used, however, hydrocortisone (HC) is becoming popular due to the possibility of less short and long-term harm. This paper will address the efficacy of HC compared to the more commonly used DXM in preventing BPD without impeding neurodevelopment in infant patients born less than 30 weeks GA.
Methods: A literature search was completed through PubMed, EBSCO host, and Google Scholar in November 2019. Seven articles consisting of retrospective observational cohort studies, double-blind placebo-controlled randomized trials, a longitudinal observational study, and an exploratory secondary analysis were selected based on relevance to the research question, study design, and publication date. The study design and results were then analyzed and compared.
Results: The evidence collected by each of the studies demonstrates statistically significant improvements in lung function and prevention of BPD with the use of GCS. Three articles compared HC with placebo. Two of these found that HC increases frequency of pts who do not develop BPD. The other shows no significant difference between HC and placebo. Two other studies focused on long term outcomes of GCS use, one finding that both DXM and HC generally reduce growth patterns. The other found that school age patients previously treated with DXM had reduced motor, cognitive and behavioral outcomes. The remaining studies analyzed adverse effects of GCS, one found that DXM shows poorer neurocognitive performance outcomes when compared to HC. The other found no significant differences in neurodevelopment at age 2 years between HC and placebo. All of these studies need to be interpreted cautiously due to their weaknesses including small sample sizes and confounding variables.
Discussion: Significant differences were found between the use of DXM compared with HC and placebo, but outcome measures and tools differ among the studies. A lack of a large sample population limited short and long-term follow up data, and minimal research directly comparing DXM to HC in the same study impede the research from attaining statistical power or clinical significance. Therefore, despite several positive findings suggesting HC as a safer and equally efficient alternative therapy to DXM, further exploration of this topic is recommended.
Conclusion: GCS should continue to be used in the management of infants born less than 30 weeks GA who are at high risk of developing BPD. Research shows the positive effects GCS have in reducing lung inflammation and preventing the development of BPD outweigh the risk of possible adverse effects. DXM is the most commonly used GCS, however, it has been associated with more short and long term adverse effects. The findings in this analysis show that HC can provide similar outcomes for prevention of BPD with less adverse effects than DXM. However, the data collected is not strong enough to recommend a change in clinical practice to HC over DXM. Future research is necessary to explore this topic and address the weaknesses of current studies.
Recommended Citation
Jones, Kelly, "Efficacy of Hydrocortisone Compared to Dexamethasone in the Prevention of BPD Without Impending Neurodevelopment in Infant Patients Born at Less Than 30 Weeks Gestational Age" (2021). Capstone Showcase. 42.
https://scholarworks.arcadia.edu/showcase/2021/pa/42
Additional Files
Kelly Jones Final PICO Poster.pdf (15389 kB)Kelly Jones PICO Presentation References.pdf (83 kB)
Efficacy of Hydrocortisone Compared to Dexamethasone in the Prevention of BPD Without Impending Neurodevelopment in Infant Patients Born at Less Than 30 Weeks Gestational Age
Introduction: Bronchopulmonary dysplasia (BPD) is a manifestation of neonatal respiratory distress syndrome (RDS) in which a deficiency of surfactant in the lungs results in labored breathing, lung collapse, and hypoxemia. Glucocorticosteroid (GCS) administration has a critical role in the prevention and management of BPD. Prolonged GCS use has been associated with adverse effects including delayed neurodevelopmental outcomes. Currently, dexamethasone (DXM) is most commonly used, however, hydrocortisone (HC) is becoming popular due to the possibility of less short and long-term harm. This paper will address the efficacy of HC compared to the more commonly used DXM in preventing BPD without impeding neurodevelopment in infant patients born less than 30 weeks GA.
Methods: A literature search was completed through PubMed, EBSCO host, and Google Scholar in November 2019. Seven articles consisting of retrospective observational cohort studies, double-blind placebo-controlled randomized trials, a longitudinal observational study, and an exploratory secondary analysis were selected based on relevance to the research question, study design, and publication date. The study design and results were then analyzed and compared.
Results: The evidence collected by each of the studies demonstrates statistically significant improvements in lung function and prevention of BPD with the use of GCS. Three articles compared HC with placebo. Two of these found that HC increases frequency of pts who do not develop BPD. The other shows no significant difference between HC and placebo. Two other studies focused on long term outcomes of GCS use, one finding that both DXM and HC generally reduce growth patterns. The other found that school age patients previously treated with DXM had reduced motor, cognitive and behavioral outcomes. The remaining studies analyzed adverse effects of GCS, one found that DXM shows poorer neurocognitive performance outcomes when compared to HC. The other found no significant differences in neurodevelopment at age 2 years between HC and placebo. All of these studies need to be interpreted cautiously due to their weaknesses including small sample sizes and confounding variables.
Discussion: Significant differences were found between the use of DXM compared with HC and placebo, but outcome measures and tools differ among the studies. A lack of a large sample population limited short and long-term follow up data, and minimal research directly comparing DXM to HC in the same study impede the research from attaining statistical power or clinical significance. Therefore, despite several positive findings suggesting HC as a safer and equally efficient alternative therapy to DXM, further exploration of this topic is recommended.
Conclusion: GCS should continue to be used in the management of infants born less than 30 weeks GA who are at high risk of developing BPD. Research shows the positive effects GCS have in reducing lung inflammation and preventing the development of BPD outweigh the risk of possible adverse effects. DXM is the most commonly used GCS, however, it has been associated with more short and long term adverse effects. The findings in this analysis show that HC can provide similar outcomes for prevention of BPD with less adverse effects than DXM. However, the data collected is not strong enough to recommend a change in clinical practice to HC over DXM. Future research is necessary to explore this topic and address the weaknesses of current studies.