Abstract
Early lung inflammation has been implicated in the pathogenesis of bronchopulmonary dysplasia (BPD). We aimed to establish the efficacy and safety of systemic hydrocortisone for the prevention of BPD. A systematic review and meta-analysis were undertaken, with a detailed electronic literature search. Trials involving preterm infants were included if they were randomised to receive systemic hydrocortisone or a placebo. The primary outcome was the composite of survival without BPD at 36-week postmenstrual age (PMA). Results are presented as relative risk (RR) or risk difference (RD) with 95% confidence intervals (CIs), along with numbers needed to treat (NNT) or harm (NNH). After filtering, 12 studies using early (within 1 week of birth) and two using late hydrocortisone were identified. Early systemic hydrocortisone significantly increased the chances of survival without BPD (RR 1.13, 95% CI [1.01, 1.26], NNT 18), and survival without moderate-to-severe neurodevelopmental impairment (1.13 [1.02, 1.26], NNT 14). Infants who received hydrocortisone had a higher risk of intestinal perforation (1.69 [1.07, 2.68], NNH 30), primarily with concurrent treatment for patent ductus arteriosus.Conclusion: Early systemic hydrocortisone is a modestly effective therapy for the prevention of BPD in preterm infants, although some safety concerns remain. No conclusions could be drawn for late hydrocortisone due to the paucity of studies.What is Known:• Preterm infants are at high risk of developing bronchopulmonary dysplasia (BPD) and early lung inflammation plays a significant role in its pathogenesis.• Both early and late systemic dexamethasone seems to reduce the incidence of BPD, but its use is associated with serious neurodevelopmental impairment at follow-up.What is New:• Early systemic hydrocortisone significantly improved survival without BPD at 36 weeks and survival without moderate to severe neurodevelopmental impairment on follow up.• Incidence of gastrointestinal perforation associated with concurrent treatment for PDA was significantly higher, although early systemic hydrocortisone reduced the need for treatment of PDAs.
Highlights
We conducted a specific and detailed systematic review and meta-analysis of systemic hydrocortisone to assess the efficacy of early or late postnatal use for the prevention of bronchopulmonary dysplasia (BPD) in preterm infants compared to placebo or active control, along with its short- and long-term safety
A total of 13 studies investigated the use of early hydrocortisone in preterm infants in the first week of life of which 12 were published as full-text articles [18,19,20,21,22,23,24,25,26,27,28,29]
As caffeine is known to have a significant effect on BPD, it was not possible to separate the effects of these two drugs from each other in the results from this study, and this abstract was excluded from further analysis
Summary
Systemic hydrocortisone is a modestly effective therapy for the prevention of BPD in preterm infants, some safety concerns remain. Group recently updated a meta-analysis of efficacy and safety of systemic steroids in preterm infants, which included data on both hydrocortisone and dexamethasone. We conducted a specific and detailed systematic review and meta-analysis of systemic hydrocortisone to assess the efficacy of early (within the first week of life) or late (beyond the first week of life) postnatal use for the prevention of BPD in preterm infants compared to placebo or active control, along with its short- and long-term safety. We have conducted a sub-group analysis of studies which had short-term respiratory endpoints as their primary outcome (BPD studies), excluding studies where hydrocortisone was used to treat hypotension, for more robust results
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