Prophylactic hydrocortisone

[Marina22]

My unit has just started prophylactic low dose hydrocortisone for all infants < 28 weeks with aim to improve survival without BPD and neurodevelopmental impairment. What is the general opinion and practice elsewhere?

[tjuren]

It is not so easy to respond. One role of HCS is circulation stabilisation, adequate stress response and renal function improoving immediately after birth. Not suitable for babies with susceptibility to hyperglykemia.

Second role is in the early stage of BPD when dexamethasone seems too strong.  As avoidable choice for lower side effects of systemic corticosteroid.

[bimalc]

On 10/28/2020 at 1:44 AM, Marina22 said:

My unit has just started prophylactic low dose hydrocortisone for all infants < 28 weeks with aim to improve survival without BPD and neurodevelopmental impairment. What is the general opinion and practice elsewhere?

I'm assuming you mean PREMILOC dosing? My units do not use it officially because our BPD program is so good and also because of questions about magnitude of effect on NDI long term, but my deep suspicion is that, in most parts of the US, the hesitancy is driven by fear of legal liability in light of the Canadian and American Academy of Pediatrics positions recommending against routine use of post-natal steroids.  Overall, I think the published evidence is sufficient to support but not mandate a change in practice, but no one in the AAP asks my opinion.

[ali]

13 hours ago, bimalc said:

I'm assuming you mean PREMILOC dosing? My units do not use it officially because our BPD program is so good and also because of questions about magnitude of effect on NDI long term, but my deep suspicion is that, in most parts of the US, the hesitancy is driven by fear of legal liability in light of the Canadian and American Academy of Pediatrics positions recommending against routine use of post-natal steroids.  Overall, I think the published evidence is sufficient to support but not mandate a change in practice, but no one in the AAP asks my opinion.

Hi bimalc, regarding your BPD, what do you feel your Unit is doing that produces such good outcomes, cos where I work we are outliers and I am trying to identify where our practice could improve? Thanks Alistair

[bimalc]

On 11/7/2020 at 12:46 PM, ali said:

regarding your BPD, what do you feel your Unit is doing that produces such good outcomes

In terms of BPD prevention we are incredibly aggressive about trial of extubation early in life with a culture that does not view early extubation 'failure' as failure; rather we celebrate everyday that these babies spend without an ET tube.  For those babies that do go on to develop severe BPD, we have a dedicated BPD-ICU providing developmentally appropriate care by a neonatologist led team of medical providers, nurses and therapist specifically practicing in this patient population.  That unit will keep kids admitted for months or even years if needed and extubate to high levels of non-invasive support as part of a pathway home without tracheostomy.  Rates of tracheostomy are very low.

Feel free to message me with your contact details and I can put you in touch with our small baby or BPD teams if you'd like. (I actually don't attend on either team; I primarily attend on our medical ICU team)

[ali]

Hi Bimalc,

I have messaged you. 

Thanks

Alistair