A multicenter randomized controlled trial published in the New England Journal of Medicine stated that hydrocortisone administered 2 to 4 weeks after birth did not reduce the incidence of bronchopulmonary dysplasia (BPD) to a significant level in preterm infants.

The trial involved around 800 preterm infants who were incubated for at least 7 days at 14 to 28 days. The infants were randomly given hydrocortisone (4 mg/kg of body weight per day tapered for 10 days) or a placebo. Infants included had a mean birth weight of 715 g, and the mean gestational age was approximately 25 weeks. 

It was observed that 16.6% of the infants who received hydrocortisone were alive and without moderate-to-severe BPD at 36 weeks postmenstrual age in comparison with 13.2% of infants in the placebo group (adjusted rate ratio [aRR] 1.27, 95% CI 0.93-1.74). More infants in the hydrocortisone group were successfully extubated compared to placebo group (44.7% vs 33.6%; RR 1.54, 95% CI 1.23-1.93), and had to spend lesser days on mechanical ventilation prior to 36 weeks of postmenstrual age (median 37 vs 40 days). Hypertension occurred more frequently in the hydrocortisone group, with 4.3% treated with an antihypertensive agentvs. 1% in the placebo group. There were no differences in survival rates without moderate-to-severe neurodevelopmental impairment between the hydrocortisone and placebo groups (36.9% vs 37.3%; aRR 0.98, 95% CI 0.81-1.18).

Thus, the study concluded that though safe, hydrocortisone showed no significant reduction in the episodes of bronchopulmonary dysplasia (BPD) in preterm infants. (MedPage Today March 23, 2022; N Engl J Med 2022; 386:1121-1131)