Short and long-term effects of systemic hydrocortisone in ventilated very preterm infants

Bronchopulmonary dysplasia (BPD) is the most common complication in survivors of preterm birth. About 30% of infants with a birthweight of less than 1500 grams develop BPD, leading to an increased risk of long-term adverse pulmonary and neurological sequela. The pathogenesis of BPD is multifactorial, but amplified pulmonary inflammation plays a critical role in its pathogenesis. Therefore, postnatal corticosteroids have been extensively investigated over the past decades. The SToP-BPD (Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants) study is a double-blind placebo-controlled randomised study investigating the safety and efficacy of systemic hydrocortisone in very preterm infants who were ventilator-dependent between 7 to 14 days after birth to reduce the incidence of death or BPD. In this thesis, the short- and long-term neurodevelopmental outcomes of the SToP-BPD study are presented.
We showed that systemic hydrocortisone initiated in the second week after birth in very preterm infants receiving mechanical ventilation improves short-term pulmonary function with only mild and often transient short-term adverse effects. We found no signs of cerebral harm in both short-term (MRI at term-equivalent age) and longer-term outcomes (neurodevelopment and behavioural outcomes at two years) after hydrocortisone treatment. Moreover, the SToP-BPD study does suggest that systemic hydrocortisone may improve the composite outcome death or NDI in the subgroup of infants born before 27 weeks’ gestation, mainly driven by its component death.