Use of hydrocortisone in extremely preterm infants: emphasis on those born least mature

Area of Science:

• Neonatal Medicine
• Endocrinology
• Pediatric Critical Care

Background:

• Extremely preterm infants may have insufficient cortisol production, leading to complications.
• Hydrocortisone (exogenous cortisol) may address relative adrenal insufficiency in neonates.
• The risks and benefits of hydrocortisone in preterm infants require careful consideration.

Purpose of the Study:

• To evaluate the effects of early prophylactic hydrocortisone on extremely preterm infants.
• To assess the impact of later-initiated hydrocortisone on ventilated infants.
• To examine hydrocortisone's role in managing hypotension in preterm infants.

Main Methods:

• Review of current data on hydrocortisone administration in extremely preterm infants.
• Analysis of outcomes including mortality, bronchopulmonary dysplasia (BPD), sepsis, and neurodevelopment.
• Assessment of hydrocortisone's efficacy in hypotension management.

Main Results:

• Early hydrocortisone may reduce mortality and BPD, and facilitate ventilation weaning.
• Increased risk of sepsis and gastrointestinal perforation observed with early hydrocortisone, especially with indomethacin.
• Late hydrocortisone improves extubation but doesn't alter mortality, BPD, or neurodevelopmental risks.
• Hydrocortisone can improve blood pressure in hypotensive preterm infants, but safety and comparative efficacy are unclear.

Conclusions:

• Early hydrocortisone shows potential benefits for extremely preterm infants but requires cautious use due to associated risks.
• Later hydrocortisone initiation is effective for extubation but lacks long-term benefits for major morbidities.
• Further research is needed to establish hydrocortisone's safety and efficacy for hypotension in preterm neonates and its impact on neurodevelopment.