Hydrocortisone use in France: current practices in 2026

Area of Science:

• Neonatalogy
• Pediatric Pharmacology
• Evidence-Based Medicine

Background:

• Recent evidence supports prophylactic hydrocortisone for improved survival without bronchopulmonary dysplasia in extremely preterm infants.
• Current French national recommendations (2010) on postnatal corticosteroids are outdated, focusing only on late use and not incorporating the latest evidence.

Purpose of the Study:

• To provide a national overview of prophylactic hydrocortisone prescribing practices in French neonatal intensive care units (NICUs).
• To identify the extent of use and reasons for non-use of early prophylactic hydrocortisone.
• To highlight the need for updated national guidelines.

Main Methods:

• A national survey was conducted between June 1 and August 13, 2024, targeting all 66 French level III NICUs.
• A structured online questionnaire was used, with one response collected per center.
• Fifty-five NICUs (83%) responded to the survey.

Main Results:

• Prophylactic hydrocortisone was used in 60% of responding NICUs (33 centers), either systematically (29%) or selectively (31%).
• Among users, 64% targeted the same infant population as the PREMILOC study.
• Non-users cited concerns regarding benefit-risk balance, lack of evidence, and absence of national guidelines. Fear of neurodevelopmental risk was significantly higher among non-users.

Conclusions:

• Hydrocortisone use in French NICUs remains heterogeneous, influenced by safety concerns and perceived uncertainty regarding evidence strength.
• Discrepancies between current evidence and clinical practice were identified.
• Updated national guidelines are essential for harmonizing evidence-based care for extremely low gestational age newborns (ELGANs).