BPD is a common complication of extreme preterm birth (for a variety of reasons) with inflammation associated mechanical ventilation potentially contributing to its development. BPD is also associated with abnormal growth, neurodevelopment and respiratory function.
While dexamethasone has been shown to have short-term respiratory benefits, long-term adverse effects (particularly cognitive impairment and cerebral palsy) have led to its decline in use.
“Hydrocortisone has several potentially advantageous qualities”, with less effect on apoptosis (programed cell death) and growth restriction on brain and body weight. Randomized clinical trials involving BPD/hydrocortisone in human infants are limited.
A double-masked, placebo controlled trial randomized 800 infants (gestational age <30 weeks; birth weight: 715gm (mean) intubated for at least 7 days between 14-28 days) to receive either hydrocortisone (4mg/kg/day) or placebo. Outcomes were measured as survival without moderate /severe BPD at 36 weeks post menstrual age (and survival without neurodevelopmental impairment at 22-26 months corrected age).
Hydrocortisone given to Intubated/mechanically ventilated preterm infants on post-natal day 14-28, DOES NOT appear to improve survival without BPD (nor does it improve neurodevelopmental outcomes).
