Association of Stress Dose Hydrocortisone with the Prevention of Bronchopulmonary Dysplasia in Extremely Preterm Neonates

Abstract

Steroids are a key component of the management of bronchopulmonary dysplasia (BPD) in preterm neonates, but certain steroids are associated with an increased risk of neurodevelopmental impairment. Hydrocortisone may be a viable option due to milder side effects, but optimal dosing and timing of use have not been established. We aimed to determine whether early administration of stress dose hydrocortisone to preterm babies during acute illness is associated with decreased incidence of BPD at 36 weeks of gestation. We retrospectively identified extremely premature neonates admitted to our neonatal intensive care unit before 24 hours of age. The primary exposure was receipt of a course of stress dose hydrocortisone (at least 3 mg/kg/day for 3 days or more) in the first 14 days of life. Our control group comprised of neonates who did not receive stress dose hydrocortisone in the first 14 days of life. We analyzed data for 375 neonates, 21 of whom received stress dose hydrocortisone in the first 14 days of life. About 90% of intervention group developed BPD vs. 64% in the control group ( P = .016). Incidence of severe BPD was significantly higher in the stress steroid group—62% vs. 23% in the control group ( P < .001). We noted that stress dose hydrocortisone administered during acute illness in the first 14 days of life was not associated with decreased incidence of BPD at 36 weeks among extremely preterm neonates. More studies are needed to determine the optimal dose and timing of steroid therapy.