Bronchopulmonary dysplasia: safety and efficacy of systemic hydrocortisone in preterm infants

  • Morris IP & al.
  • Eur J Pediatr
  • 29 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In pre-term infants, early systemic hydrocortisone therapy was effective in increasing the chances of survival without bronchopulmonary dysplasia (BPD) at 36 weeks post-menstrual age (PMA).
  • Treatment was also associated with survival without moderate-to-severe neurodevelopmental impairment (NDI) on follow-up.

Why this matters

  • BPD remains a common preterm birth complication and is associated with long-term pulmonary morbidity and NDI.
  • The use of both early and late systemic dexamethasone seems to reduce the incidence of BPD but is associated with serious NDI at follow-up.

Study design

  • Meta-analysis identified 12 studies using early (within 1 week of birth) and 3 using late hydrocortisone after a search on Embase, Medline and the Cochrane Central Register of Controlled Trials
  • Primary outcome: composite of survival without BPD at 36-week PMA.
  • Funding: None

Key results

  • Pooled estimate (1378 infants) suggested that early systemic hydrocortisone significantly increased the chances of survival without BPD in the first week of life (relative risk [RR], 1.13; 95% CI, 1.01-1.26; P=.04; number needed to treat [NNT], 18).
  • Early systemic hydrocortisone significantly increased the chances of survival without moderate-to-severe NDI (RR, 1.13; 95% CI, 1.02-1.26; P=.02; NNT, 14).
  • Gastrointestinal perforation, primarily with concurrent treatment for patent ductus arteriosus was significantly higher in the group of infants receiving hydrocortisone (RR, 1.69; 95% CI, 1.07-2.68; P=.03; number needed to harm, 30).

Limitations

  • Number of trials had small numbers of infants increasing the chance of a type-I error.

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