Abstract
BACKGROUND: A recent trial and meta-analysis have shown that prophylactic hydrocortisone is associated with lower rates of bronchopulmonary dysplasia (BPD) among extremely preterm infants. OBJECTIVES: To evaluate the real-world effects of prophylactic hydrocortisone (pHCT) on the odds of death or BPD. Secondary objectives assessed respiratory and safety outcomes. DESIGN/METHODS: A multi-center retrospective cohort study of infants born <28 weeks gestation and admitted to a Neonatal Intensive Care Unit in the Canadian Neonatal Network 2019-2023. Infants who received pHCT were compared 1:1 to propensity score matched controls who did not. The primary outcome was death or moderate to severe BPD. Hierarchical outcomes were explored with win odds analysis applied. Logistic regression analysis was used to calculate adjusted odds ratios (aOR) of primary and secondary outcomes. RESULTS: The study population included 361 infants per group with median gestational age 25 weeks (IQR 24, 26) and baseline characteristics were balanced between groups (absolute standardized differences <0.1). There was no difference in the odds of death or moderate to severe BPD nor was there a difference in duration of invasive and non-invasive ventilation (Table 1). There was lower use of postnatal steroids and treatment of patent ductus arteriosus in the pHCT group, but no significant difference in other safety outcomes was observed (Table 2). Hierarchical composite endpoint analysis also did not show significant difference in the primary outcome with win odds (95% CI) of 1.02 (0.85, 1.28). CONCLUSION: Prophylactic hydrocortisone was not associated with reductions in mortality nor moderate to severe BPD, but was associated with lower use of additional postnatal steroids and treatment of patent ductus arteriosus. [Figure: see text] [Figure: see text]