Membrane stabilizing effect of steroids?

[Gustaf Lernfelt]

Hi,
 

While working the past couple of weeks, there has been some discussion on the possible membrane stabilizing effects of hydrocortisone. Is this something you would consider in your practice, in which cases, and what dose would you use? Whats is the evidence and rationale behind it?

Best,

Gustaf

[Stefan Johansson]

Hi Gustaf! Yes, this was a saying I was also taught at the Kungliga Karolinska NICU back in the days, when used in situations that were complicated… so, wisdom from the walls? I really don’t know the literature, but certainly this had an impact on blood pressure and short term lung issues (extubation).

My thought now - steroids should ideally be given on clinically defined indications, e.g. for BPD prevention (if one has faith in those studies). I assume it also has some role for infants stuck on the vent, to facilitate extubation (?)

Apologies for this un-initiated reply  

[Jessica]

Do you have article ?  thanks 🇧🇷

[Stefan Johansson]

A bit tricky to find seemingly relevant references about corticosteroids and "membrane stabilisation" in preterm infants.

I did find some old references, for example this one https://www.jci.org/articles/view/107832

Otherwise, when it comes to the Q's about BPD prevention - I would you to look at the latest Cochrane meta-analysis and the two PREMILOC publications (which IMHO is a promising strategy)

• https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010941.pub3/full
• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00202-6/abstract
• https://www.nature.com/articles/s41390-023-02785-x

[Gustaf Lernfelt]

In this particular case we were handling a suspected capillary leak syndrome, so I did some reading up on different treatments. Steroids was one treatment we considered. I ended up with an article form Iowa being most usefull: https://pubmed.ncbi.nlm.nih.gov/39123307/

It discussed possible treatment strategies (theophylline, IVIG, hydrocortisone) and provided a good supplemental with dosing suggestions. 

I also found an article on Haemodynamic effects of prophylactic post-operative hydrocortisone following cardiopulmonary bypass in neonates undergoing cardiac surgery: https://pubmed.ncbi.nlm.nih.gov/36950894/

But it was a retrospective, small sample size, with various other treatment regimes within the groups, so it didn't give that much. Except contributing to a possible dosing regime discussion.

Another article proposed to give 3% NaCl boluses follwed by furosemide to treat a possible capillary leak. Due to it's fairly simple approach without too serious side effects it seemed like an attractive solution to the problem. But we never needed to try it out. https://pubmed.ncbi.nlm.nih.gov/38429824/

And since this was an overall edematous infant I also stumbled upon an article called: Neonatal fluid overload: ignorance is no longer bliss. Which covered everything we had tried (except for dialysis), it was a fairly good read. https://pubmed.ncbi.nlm.nih.gov/35348902/