Early Steroid Use Improves Premature Infant Survival
A multinational randomized trial reports that administering hydrocortisone early to extremely premature infants increases survival rates without bronchopulmonary dysplasia (chronic lung disease). The Linköping University-led study found the treatment significantly improved the likelihood of survival without major respiratory complications compared to a placebo. The evidence could lead to changes in neonatal intensive care protocols.
- The study, led by Professor Ulrika Ådén, analyzed data from the Swedish national neonatal registry for 474 infants born between 22 and 27 weeks' gestation who received hydrocortisone, comparing them to 632 infants born before the treatment was introduced. - Bronchopulmonary dysplasia (BPD) affects more than half of babies born before 28 weeks of pregnancy and is associated with long-term complications, including reduced lung function, cognitive impairments, and a higher risk of respiratory infections into adulthood. - The rationale for the treatment is that extremely premature infants are often cortisol-insufficient; the low-dose hydrocortisone is intended to act as a physiological replacement that reduces the inflammatory cascade in the underdeveloped lungs. - Historically, the use of a more potent steroid, dexamethasone, to prevent BPD was associated with an increased risk of adverse neurodevelopmental outcomes, including cerebral palsy, which led to caution regarding steroid use in this population. - Hydrocortisone is a shorter-acting corticosteroid and is considered a safer alternative to dexamethasone, with studies showing fewer short-term side effects on blood pressure and blood sugar, and better long-term neurodevelopmental outcomes. - The PREMILOC trial, a major earlier French study, used a 10-day course of low-dose hydrocortisone (a total cumulative dose of 8.5mg/kg) and found it significantly increased survival without BPD. - While an individual patient data meta-analysis showed early hydrocortisone was associated with an increased risk of late-onset sepsis and spontaneous intestinal perforation, the perforation risk was primarily linked to concurrent use with indomethacin. - Beyond lung health, the treatment was also found to decrease the odds of needing medical intervention for a patent ductus arteriosus (PDA), a common heart problem in premature infants.
