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Outcomes in extremely preterm neonates after the introduction of early low-dose hydrocortisone treatment: A

Ellie Purcell1, Pooja Sachdev2, Dushyant Batra3

  • 1School of Medicine, University of Nottingham, United Kingdom of Great Britain and Northern Ireland.

Early Human Development
|December 24, 2025
PubMed

Insights

Early low-dose hydrocortisone (ELDH) did not improve survival without bronchopulmonary dysplasia (BPD) in extremely preterm infants. ELDH was linked to increased sepsis and longer respiratory support needs.

Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Pharmacology

Background:

  • Extremely preterm neonates face high risks of bronchopulmonary dysplasia (BPD).
  • Early low-dose hydrocortisone (ELDH) is explored as a potential intervention.
  • The PREMILOC study protocol guides ELDH administration within 24 hours of birth.

Purpose of the Study:

  • To assess the association between ELDH use and BPD-free survival at 36 weeks completed gestational age (CGA).
  • To evaluate secondary outcomes, including mortality, sepsis, and respiratory support duration.

Main Methods:

  • Retrospective, matched case-control study involving 188 extremely preterm neonates.
  • Cases received ELDH (8.5 mg/kg over 10 days) within 24 hours of life.
  • Controls did not receive ELDH; data collected from tertiary neonatal intensive care units.

Main Results:

  • No significant association between ELDH and improved BPD-free survival (p=0.153) or reduced mortality (p=0.814).
  • ELDH use was significantly associated with increased culture-positive late-onset sepsis (p=0.006).
  • Higher non-invasive respiratory support days (p=0.032) and longer total length of stay (p=0.004) were observed with ELDH.

Conclusions:

  • ELDH did not enhance BPD-free survival in extremely preterm neonates.
  • ELDH use correlated with increased sepsis incidence and prolonged respiratory support.
  • Further research is needed to identify preterm neonates who may benefit from ELDH.
Abstract

Keywords:
Bronchopulmonary dysplasiaHydrocortisoneMortalityPreterm

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