P2.E098: Timing of Hydrocortisone Use in Preterm Infants: Evolving Practice Patterns

Background: Hydrocortisone is widely used in neonatal intensive care units (NICUs) for multiple reasons including the prevention of BPD and treatment of hypotension secondary to relative adrenal insufficiency. Previous studies have explored timing, frequency, and dosing of hydrocortisone in preterm infants with the aim of understanding its effect on survival without BPD in extremely preterm infants. However, hydrocortisone’s safety and efficacy profile in infants remains unclear, leading to a lack of standardization of its use. The purpose of this study is to describe the patterns of hydrocortisone use over time in NICUs across the United States.

Methods: We conducted a cohort study of infants born at 23 – 30 weeks gestational age (GA) between 2010-2020 at Pediatrix Medical Group NICUs. We excluded infants with major congenital anomalies and infants transferred to outside hospitals. We divided timing of hydrocortisone initiation into early (≤7 days postnatal age) and late (>7 days postnatal age). We used summary statistics to describe demographics and clinical characteristics of infants who received hydrocortisone and those who did not. We evaluated the change in the overall use of hydrocortisone over time using the Cuzick’s trend test.

Results: From 306 NICUs, 70,056 infants met the inclusion criteria. Demographics and clinical characteristics are outlined in Table 1. The median GA of the cohort was 28 (25th-75th percentile: 26-29) weeks and median birthweight (BW) was 1070 (810-1320) grams. Of the total cohort, 7850 (11%) infants were exposed to any hydrocortisone: 5% in the early group and 6% in the late group (Table 1). Exposed infants had lower GA and birthweight (Table 1, p< 0.001). The median start day was postnatal day 1 (0-3) for early hydrocortisone and postnatal day 18 (12-28) for late administration. Most of the infants exposed to early and late hydrocortisone were exposed for < 14 days (p < 0.001). Hydrocortisone use, particularly early administration, increased overall from 2010 to 2020 (Figure 1; p< 0.001).

Conclusion: The use of hydrocortisone has overall increased from 2010 through 2020, particularly in early use after 2016. GA and BW are inversely associated with hydrocortisone use. However, more studies are warranted to understand the optimal time of initiation, dosing, and length of hydrocortisone use for specific indications.