083 - Correlation of Hemodynamic Status with Dose-Dependent Exposure to Prophylactic Hydrocortisone in First 72 hours After Birth in Extremely Preterm Population

Publication Number: 83.4350

Amisha P. Tarkunde, University of Washington School of Medicine, Seattle, WA, United States; Robert H. Schmicker, University of Washington, Seattle, WA, United States; Claire B. Vietri, University of Washington School of Medicine, Seattle, WA, United States; Madison Lodge, Seattle Children's, Seattle, WA, United States; Tiffany Stanley, University of Washington School of Medicine, seattle, WA, United States; Victoria Quach, University of Washington School of Medicine, Seattle, WA, United States; Kendell German, University of Washington School of Medicine, Seattle, WA, United States; Ulrike Mietzsch, University of Washington School of Medicine, Seattle, WA, United States; Kirtikumar Upadhyay, University of Washington School of Medicine, Seattle, WA, United States; Krystle M.. Perez, University of Washington, Seattle, WA, United States; Sarah E. Kolnik, University of Washington - Seattle Children's Hospital, Seattle, WA, United States

Background: Extremely preterm (EP) are at high risk of adrenal insufficiency as well as morbidities associated with impaired end organ perfusion. Current methods to improve hemodynamic status such as normal saline boluses (NSB) and vasoactive medications (VA) have been associated with poor outcomes, making HCT an attractive alternative. The effect of prophylactic HCT for hemodynamic support in EP infants has not been established.

Objective: The aim of this study is to characterize changes in hemodynamic status in infants born between 22-24 6/7 GA exposed to HCT, change in need for hemodynamic support in the first 72 hours after birth, and the association with short term outcomes related to end organ perfusion.

Design/Methods: This retrospective observational study of infants born at 22 0/7 - 24 6/7 weeks’ GA and/or < 500g birthweight (bw) at a Level IV NICU. Variables were extracted from the electronic medical record. Hourly hemodynamic metrics were aligned in time-series including heart rate, regional cerebral oxygenation (rScO2), mean arterial and systolic blood pressure, peripheral oxygen saturation (SpO2), base deficit, and lactate. Short term outcomes were defined as intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP) and death. A correlation matrix was created to summarize univariate frequency and between variable correlations for 8 hemodynamic markers over the first 72 hours after birth. The association between NSB, VA medications or short-term outcomes and total daily HCT dose in the first 72 hours was assessed using logistic regression models, adjusted for GA, bw, and severity of illness using CRIB-II score.

Results: 23 infants included in this study are described in Table 1. There was no strong linear correlation in HCT dose and hemodynamic metrics (Figure 1). Further correlation matrix sub-analysis in 24-hour increments showed a significant positive correlation between HCT dose and rScO2 during hours 48-72 (Pearson coefficient 0.44, p< 0.05). There was a positive association of HCT dose to NSB (p=0.004) and VA medications (p=0.006) (Table 2). There was no difference between HCT dose for infants who developed severe IVH, NEC, SIP, and mortality (Table 2).

Conclusion(s): In this cohort of EP infants, increasing total daily HCT dose did not mitigate the use of NSB or VA medications nor was it associated with changes in IVH, NEC, SIP, or death. There was a positive correlation between HCT and rScO2 between 24-48 hours. Future studies with a larger sample size are needed to fully elucidate HCT potential hemodynamic effects.

Table 1. Demographics
a) Other includes 1 Asian, 1 Multiracial, 3 “Other, unspecified”, and 3 unreported
b) Hypertension includes 4 with chronic hypertension and 1 with gestational hypertension
c) Vasoactive medications use included dopamine (n=4), dobutamine (n=1)
d) Sedative drips included morphine (n=6), dexmetomidine (n=2)

Figure 1.
Correlation matrix plot illustrates the relationship between hourly hemodynamic metrics and hydrocortisone level in the first 72 hours after birth. Numerical values indicate the correlation coefficient between two variables. Significant correlations are indicated by *** (p <0.001) and * (p < 0.05). Smaller “*” indicates p-value between 0.05-0.10. HCT, hydrocortisone; HR, heart rate; MAP, mean arterial pressure; SpO2, peripheral oxygenation; rScO2, regional cerebral oxygen saturation as measured by near-infrared spectroscopy; BD, base deficit; Lac, lactate; SBP, systolic blood pressure

Table 2.
Total daily dose effects of hydrocortisone in the first 72 hours after birth on (A) use of normal saline boluses and vasoactive medications and (B) in-hospital outcomes. Adjusted for GA, birthweight, and CRIB-II score