250 - Increased Survival Without BPD in Extremely Preterm Infants When Exposed to early Prophylactic Hydrocortisone - A Swedish Population-Based Register Study

Publication Number: 250.5423

Veronica Smedbäck, Linköping University, Huskvarna, Jonkopings Lan, Sweden; Lars J. Björklund, Children's Hospital, Lund, Skane Lan, Sweden; Anders H. Flisberg, University Gothenburg , Neonatal Department, Gothenburg, Vastra Gotaland, Sweden; Jolanta Anna. Wróblewska, NeoIVA, Norrlands Universitetssjukhuset, Umeå, Umeå, Vasterbottens Lan, Sweden; Erik Wejryd, Linköping University, Norrköping, Ostergotlands Lan, Sweden; Ulrika Åden, Linköping, Linköping, Ostergotlands Lan, Sweden; Olivier Baud, APHP Port-Royal, paris, Ile-de-France, France

Background: Bronchopulmonary dysplasia (BPD) is common among infants born extremely preterm. Dexamethasone has previously been used to prevent or treat BPD but is associated with adverse effects, including neurodevelopmental impairment. Early low-dose prophylactic hydrocortisone (PHC) has been investigated and shows promising results in preventing BPD with fewer adverse effects. In Sweden, some regions have implemented the routine use of PHC since 2020.

Objective: Investigate a possible association between early PHC and survival without BPD at 36 weeks postmenstrual age (PMA) in extremely preterm infants born in Sweden from 2018 to 2023. Additionally, the study aims to evaluate the safety of early PHC by examining severe neonatal morbidities evident before 36 weeks PMA, particularly spontaneous intestinal perforation and late-onset sepsis.

Design/Methods: Data on all infants born before 28 weeks of gestation and admitted to neonatal care in Swedish centers where PHC was introduced from 2018 to 2023 (n=1112) were retrieved from the Swedish Neonatal Quality Register. Infants were classified as exposed (n=477) or non-exposed (n=635) and compared regarding background characteristics and outcomes. Logistic regression was used after adjusting for confounders. To ensure robustness, all analyses were repeated using propensity score-matched groups, taking all background characteristics into account.

Results: A total of 1112 infants were included in the main analysis. Survival without BPD was significantly more common in infants exposed to PHC (adjusted odds ratio 1.53; 95% confidence interval 1.10–2.14). The strongest association was found in the subgroup of infants born at 24–25 weeks of gestation. In a secondary analysis, a significantly decreased incidence of BPD, but not mortality, was observed among infants exposed to PHC. No significant increase was seen in the investigated safety variables for those exposed to PHC, except for the diagnosis of ROP grade 3–4.

Conclusion(s): In this population-based register study of infants born at 22 to 27 weeks of gestation, exposure to early postnatal low-dose hydrocortisone was associated with significantly higher survival without BPD. Long-term neurodevelopmental and pulmonary follow-up is warranted.

Primary outcome


Primary outcome stratified by gestational age at birth


Safety variables