LAUSR

Hydrocortisone is often used for extremely preterm babies at risk of bronchopulmonary dysplasia (BPD), but efficacy is uncertain. Furthermore, use of hydrocortisone from birth in such babies has been associated with impaired neurodevelopment. In a US-based randomised controlled trial, 800 infants gestational age <30 weeks who had been intubated for at least 7 days were randomised at 14–28 days of age to receive either hydrocortisone (4 mg/kg/day tapered over 10 days) or placebo. Mean [ SD] birthweight was 715 167 g and mean gestational age was 24.9 1.5 weeks. At 36 weeks of age, 66 of 398 infants (16.6%) in the hydrocortisone group and 53 of 402 (13.2%) in the placebo group survived without moderate or severe BPD (adjusted rate ratio, aRR 1.27; 95% confidence interval [CI], 0.93–1.74). At 2 years of age, with 91% follow-up, 132 of 358 infants (36.9%) in the hydrocortisone group and 134 of 359 (37.3%) in the placebo group survived without moderate or severe neurodevelopmental impairment (aRR 0.98; 95% CI, 0.81–1.18). Hypertension treated with medication was more frequent with hydrocortisone than with placebo (4.3% vs. 1.0%; aRR = 4.27; 95% CI, 1.45–12.55). Other adverse events were similar between the two groups. This important randomised controlled trial suggests late hydrocortisone does not prevent BPD and may be harmful.