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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.

Seminars in Fetal & Neonatal Medicine
|May 3, 2019
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
Bronchopulmonary dysplasiaHydrocortisoneInflammationPrematurity

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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.