Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial
Related Experiment Video
Updated: Aug 20, 2026
Intratracheal Instillation of Stem Cells in Term Neonatal Rats
Published on: May 4, 2020
Kristi L Watterberg1, Jeffrey S Gerdes, Cynthia H Cole
1Division of Neonatology, Department of Pediatrics/Neonatology, University of New Mexico School of Medicine, MSC10 5590, Albuquerque, NM 87131-0001, USA. kwatterberg@salud.unm.edu
Insights
Low-dose hydrocortisone did not improve survival without bronchopulmonary dysplasia (BPD) in all infants. However, it significantly reduced mortality and improved survival without BPD in infants with histologic chorioamnionitis.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Endocrinology
Background:
- Infants with bronchopulmonary dysplasia (BPD) exhibit diminished cortisol response to adrenocorticotropic hormone.
- Pilot studies suggested low-dose hydrocortisone may improve survival without BPD, especially in infants with histologic chorioamnionitis.
Purpose of the Study:
- To evaluate the efficacy of low-dose hydrocortisone for prophylaxis of early adrenal insufficiency in mechanically ventilated infants.
- To determine the impact of hydrocortisone on survival without BPD and other clinical outcomes.
Main Methods:
- A multicenter, randomized, masked trial involving mechanically ventilated infants (500-999 g birth weight).
- Infants received either placebo or hydrocortisone (1 mg/kg/day for 12 days, then 0.5 mg/kg/day for 3 days).
- BPD was defined clinically and physiologically at 36 weeks' postmenstrual age.
Main Results:
- Enrollment stopped early due to increased gastrointestinal perforation in the hydrocortisone group.
- Overall survival without BPD, mortality, and growth parameters were similar between groups.
- In infants with histologic chorioamnionitis, hydrocortisone significantly decreased mortality and improved survival without BPD.
Conclusions:
- Prophylactic hydrocortisone did not improve overall survival without BPD.
- Hydrocortisone treatment significantly benefited infants exposed to histologic chorioamnionitis.
- Low-dose hydrocortisone did not suppress adrenal function or impair short-term growth; however, concurrent use with indomethacin should be avoided due to increased gastrointestinal perforation risk.
Background:
Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response to adrenocorticotropic hormone. A pilot study of low-dose hydrocortisone therapy for prophylaxis of early adrenal insufficiency showed improved survival without BPD at 36 weeks' postmenstrual age, particularly in infants exposed to histologic chorioamnionitis.
Methods:
Mechanically ventilated infants with birth weights of 500 to 999 g were enrolled into this multicenter, randomized, masked trial between 12 and 48 hours of life. Patients received placebo or hydrocortisone, 1 mg/kg per day for 12 days, then 0.5 mg/kg per day for 3 days. BPD at 36 weeks' postmenstrual age was defined clinically (receiving supplemental oxygen) and physiologically (supplemental oxygen required for O2 saturation > or =90%).
Results:
Patient enrollment was stopped at 360 patients because of an increase in spontaneous gastrointestinal perforation in the hydrocortisone-treated group. Survival without BPD was similar, defined clinically or physiologically, as were mortality, head circumference, and weight at 36 weeks. For patients exposed to histologic chorioamnionitis (n = 149), hydrocortisone treatment significantly decreased mortality and increased survival without BPD, defined clinically or physiologically. After treatment, cortisol values and response to adrenocorticotropic hormone were similar between groups. Hydrocortisone-treated infants receiving indomethacin had more gastrointestinal perforations than placebo-treated infants receiving indomethacin, suggesting an interactive effect.
Conclusions:
Prophylaxis of early adrenal insufficiency did not improve survival without BPD in the overall study population; however, treatment of chorioamnionitis-exposed infants significantly decreased mortality and improved survival without BPD. Low-dose hydrocortisone therapy did not suppress adrenal function or compromise short-term growth. The combination of indomethacin and hydrocortisone should be avoided.
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:30Asthma-IV: Nursing Management
First, in...