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Prophylactic postnatal corticosteroids: Early hydrocortisone
Olivier Baud1, Kristi L Watterberg2
1Division of Neonatology and Pediatric Intensive Care, University Hospitals Geneva, Geneva, Switzerland.
Insights
Early low-dose hydrocortisone prophylaxis in extremely preterm infants significantly reduces bronchopulmonary dysplasia (BPD) and mortality. This treatment aids stressed newborns in managing pulmonary inflammation and improves outcomes.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Endocrinology
Background:
- Inflammation is central to bronchopulmonary dysplasia (BPD) pathogenesis in preterm infants.
- Cortisol deficiency impairs stress response and pulmonary inflammation control in neonates.
- Lower cortisol levels and adrenocorticotropic hormone response are observed in infants who develop BPD.
Purpose of the Study:
- To evaluate the efficacy of early low-dose hydrocortisone prophylaxis in preventing BPD in extremely preterm infants.
- To assess the impact of hydrocortisone on mortality, patent ductus arteriosus, and other morbidities.
Main Methods:
- Analysis of four randomized clinical trials involving nearly 1000 extremely preterm infants.
- Administration of early low-dose hydrocortisone for adrenal insufficiency prophylaxis.
Main Results:
- Hydrocortisone significantly decreased BPD incidence and mortality.
- Medical treatment for patent ductus arteriosus was also reduced.
- No increased mortality or adverse neurodevelopmental outcomes were observed despite a rise in late-onset sepsis in the most immature infants.
- Gastrointestinal perforation did not increase when indomethacin was absent.
Conclusions:
- Early low-dose hydrocortisone is beneficial for extremely preterm infants at high risk for BPD.
- The treatment improves survival and reduces major morbidities.
- Hydrocortisone prophylaxis is a well-supported intervention for this vulnerable population.
Abstract:
Inflammation is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in preterm infants, and cortisol plays a central role in controlling inflammation. Insufficient cortisol limits the ability of the sick newborn to handle stress and inhibit pulmonary inflammation. Evidence of lower cortisol and lower response to adrenocorticotropic hormone in infants subsequently developing BPD led to studies of early low-dose hydrocortisone to prevent BPD. Based on four randomised clinical trials enrolling almost 1000 extremely preterm infants, prophylaxis of early adrenal insufficiency with low-dose hydrocortisone significantly decreased BPD and mortality, as well as medical treatment for a patent ductus arteriosus. An increase in late-onset sepsis reported in the most immature infants had no adverse effect on mortality or neurodevelopmental outcomes. There was no increase in gastrointestinal perforation in the absence of indomethacin. The demonstrated beneficial effects of early low-dose hydrocortisone make a strong case for its use in extremely preterm infants at high risk for BPD.
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