Postnatal hydrocortisone for preventing or treating bronchopulmonary dysplasia in preterm infants: a systematic review.
BACKGROUND
Corticosteroids have been used widely after birth in preterm infants with respiratory failure; hydrocortisone may be preferable to other corticosteroids for this purpose.


OBJECTIVE
To determine if postnatal hydrocortisone is useful to prevent or treat bronchopulmonary dysplasia (BPD) in preterm infants.


METHODS
Randomised controlled trials (RCTs) of postnatal hydrocortisone therapy to prevent or treat BPD were sought. Data regarding clinical outcomes including mortality, BPD, death or BPD, complications during the primary hospitalisation, and long-term outcome were abstracted and analysed using RevMan 5.


RESULTS
Eight RCTs enrolling a total of 880 participants were eligible. In all trials treatment was started in the first week of life; there were no trials of treatment started in infants who were chronically ventilator-dependent after the first week of life with established or evolving BPD. A meta-analysis of the available trials demonstrated little evidence for a direct effect of hydrocortisone on the rates of BPD, mortality, or the combined outcome of BPD or mortality. Hydrocortisone in the doses used in these eight studies had few beneficial or harmful effects; the notable exception was an increase in gastrointestinal perforation.


CONCLUSIONS
Postnatal hydrocortisone in the doses and regimens used in the reported trials has few beneficial or harmful effects and cannot be recommended for prevention of BPD. There are no randomised trials to substantiate the use of hydrocortisone in chronically ventilator-dependent infants with established or evolving BPD.
Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, and Murdoch Children's Research Institute, Parkville, Vic., Australia. lwd@unimelb.edu.au
Lex W
LW
Doyle
Richard A
RA
Ehrenkranz
Henry L
HL
Halliday
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D007416:Intestinal Perforation / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone