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Prophylactic low-dose hydrocortisone in neonates born extremely preterm: current knowledge and future challenges
Olivier Baud1,2,3, Héloïse Torchin4,5, Marine Butin6,7
1Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health, Université Paris Cite, CRESS, INSERM, INRAE, Paris, France. olivbaud@gmail.com.
Pediatric Research
|November 26, 2024
Summary
Prophylactic hydrocortisone in extremely low gestational age neonates (ELGANs) improves survival without bronchopulmonary dysplasia (BPD). While generally safe, optimal treatment strategies require further investigation.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Critical Care
Background:
- Extremely low gestational age neonates (ELGANs) have immature adrenal glands, impairing their response to postnatal stress.
- This immaturity can lead to serious complications like death and bronchopulmonary dysplasia (BPD).
Purpose of the Study:
- To review the evidence on prophylactic low-dose hydrocortisone in ELGANs.
- To assess its benefits, risks, and ongoing challenges in clinical practice.
Main Methods:
- Systematic review of clinical trials and analysis of recent real-world data.
- Discussion of implementation challenges and future research directions.
Main Results:
- Prophylactic hydrocortisone reduces pre-discharge mortality and improves survival without BPD.
- Benefits include patent ductus arteriosus (PDA) closure and improved cardiovascular stability.
- Potential risks include increased spontaneous intestinal perforation and late-onset sepsis in specific subgroups.
Conclusions:
- Prophylactic hydrocortisone is beneficial for ELGANs, improving survival outcomes.
- Real-world data support trial findings, showing additional benefits without increased adverse events.
- Further research is needed on optimal patient selection, timing, and duration of treatment.
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