Hydrocortisone use in France: current practices in 2026

Over the past decade, new evidence has emerged regarding postnatal corticosteroids use in extremely preterm infants, particularly early prophylactic hydrocortisone. In France, national recommendations published in 2010 address late postnatal corticosteroids use only and do not incorporate the most evidence-based data. We aimed to provide a national overview of prescribing practices in French neonatal intensive care units (NICUs), focusing on prophylactic hydrocortisone. A national survey was conducted between 1 June and 13 August 2024 among all 66 French level III NICUs using a structured online questionnaire. One response per center was gathered. Fifty-five of 66 (83%) NICUs responded. Prophylactic hydrocortisone was used in 33 (60%) centers: 16 (29%) systematically and 17 (31%) selectively. Among users, 21 (64%) targeted the same population as the PREMILOC study. Non-users cited concerns about benefit-risk balance, lack of evidence, and absence of national guidelines. Fear of neurodevelopmental risk was more frequent among non-users (9/22 (41%) vs 1/33 (3%), p < 0.001), while perceived spontaneous intestinal perforation risk did not differ.

Hydrocortisone use in French NICUs remain heterogeneous due to safety concerns and a possible uncertainty about the strength of evidence. These findings underscore the need for updated national guidelines to support harmonized, evidence-based care for ELGANs.

• Recent evidence supports prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia in extremely preterm infants. • French national recommendations (2010) address late corticosteroid use (beyond 3 weeks) and do not incorporate recent evidence-based data.

• This national survey provides the first overview of hydrocortisone use in French NICUs, highlighting heterogeneity in prescribing practices. • It identifies discrepancies between evidence and clinical practice, supporting the need for updated guidelines.