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Effect of Systemic Hydrocortisone in Ventilated Infants Born Preterm: Mortality and 5.5-Year Neurodevelopmental

T de Baat1, M van de Loo1, C S H Aarnoudse-Moens2

  • 1Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Reproduction & Development research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

The Journal of Pediatrics
|December 14, 2025
PubMed

Insights

Hydrocortisone treatment in preterm infants did not improve neurodevelopmental outcomes or reduce mortality by age 5.5. This study found no significant differences in cognitive, motor, or neurosensory functions between hydrocortisone and placebo groups.

Area of Science:

  • Neonatal Medicine
  • Pediatric Neurology
  • Developmental Pediatrics

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants requiring mechanical ventilation.
  • Early administration of systemic hydrocortisone (HC) has been explored to prevent BPD and improve outcomes.
  • The Systemic hydrocortisone (HC) To Prevent Bronchopulmonary Dysplasia in preterm infants (SToP-BPD) study investigated HC's efficacy.

Purpose of the Study:

  • To evaluate neurodevelopmental outcomes at 5.5 years corrected age in preterm infants from the SToP-BPD study.
  • To compare neurodevelopmental outcomes and mortality between HC treatment and placebo in mechanically ventilated preterm infants.
  • To assess the impact of HC initiated between 7 and 14 days after birth.

Main Methods:

  • Longitudinal follow-up data collected at 5.5 years corrected age.
  • Assessment of cognitive, motor, neurosensory functioning, behavior, schooling, and general health.
  • Primary outcome: death or moderate-severe neurodevelopmental impairment (NDI), defined by deficits in cognition, motor, vision, or hearing.

Main Results:

  • NDI assessed in 77% of surviving children; follow-up participants had more educated/non-smoking parents and better prior outcomes.
  • No significant difference in the primary outcome (death or moderate-severe NDI) between HC and placebo groups (OR 0.75; 95% CI 0.49-1.14; P = .18).
  • All separate developmental outcomes, including cognitive, motor, and neurosensory assessments, were comparable between treatment arms.

Conclusions:

  • Systemic hydrocortisone treatment initiated between 7 and 14 days in preterm infants at risk for BPD did not impact death or moderate-severe NDI at 5.5 years corrected age.
  • HC treatment did not significantly alter any individual developmental outcome measures at the 5.5-year follow-up.
  • These findings suggest that early HC administration in this vulnerable preterm population does not confer long-term neurodevelopmental benefits.
Abstract

Keywords:
bronchopulmonary dysplasiafollow-uphydrocortisoneneurodevelopmentpreterm

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