Early Hydrocortisone Treatment Improves Survival Without Chronic Lung Disease in Extremely Premature Babies

A study led by Linköping University indicates that early hydrocortisone treatment for extremely premature babies increases their chances of survival without developing bronchopulmonary dysplasia (BPD), a chronic lung disease.

The research also concluded that the treatment is safe to administer.

Understanding Bronchopulmonary Dysplasia (BPD)

BPD affects over half of babies born extremely prematurely (before 28 weeks of pregnancy), often resulting in lifelong health issues. The disease is caused by underdeveloped lungs in premature infants, with inflammation identified as a key contributing factor. Cortisone, a hormone, suppresses inflammation, but extremely premature babies often cannot produce sufficient amounts. Previous studies on preventive hydrocortisone treatment had shown potential benefits but also raised concerns about severe side effects.

Study Methodology: A Natural Experiment

The study utilized a "natural experiment" in Sweden, where some regions had introduced guidelines for hydrocortisone treatment from the first day after birth, while others had not. Researchers analyzed data from the national neonatal registry, comparing 474 children who received hydrocortisone treatment with 632 children born in the same regions before the treatment's introduction, as well as with children from regions not providing the treatment. All infants included in the study were born between 22 and 27 weeks of pregnancy, from 2018 to 2023.

Key Findings

• The study found that early hydrocortisone treatment increases the chance of extremely premature babies surviving without BPD.
• Hydrocortisone treatment was determined to be safe and did not increase the risk of serious side effects during the newborn period.

Implications and Future Research

Bronchopulmonary dysplasia is associated with an increased risk of infections, hospitalizations, impaired weight gain, and negative effects on brain development in children.

Researchers suggest that preventive treatment could significantly benefit affected children, their families, and society by potentially reducing care needs.

Given the high prevalence of BPD in extremely premature infants globally, this treatment could have widespread impact. The current study focused on short-term safety. Researchers plan to investigate the longer-term effects of the treatment, particularly on brain development, as other studies have indicated potential positive effects.