Early human development · 2026
Hydrocortisone for evolving respiratory failure in preterm infants: predictors of treatment failure and associations with bronchopulmonary dysplasia. A retrospective cohort study.
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Van den Boom K J T, Dieleman J P, Regis M, Andriessen P, Niemarkt H J
Аннотация
AIM: To identify predictors of hydrocortisone treatment failure and examine its association with bronchopulmonary dysplasia (BPD) in preterm infants.
METHODS: Retrospective single-centre cohort study including infants born at 240-296 weeks' gestation (2013-2023) who received a standardized hydrocortisone course (cumulative dose 72.5 mg/kg) to facilitate extubation or avoid intubation. Treatment failure at day 21 was defined as death, ongoing mechanical ventilation, FiO₂ ≥ 0.40, inability to taper hydrocortisone according or escalation to dexamethasone. Logistic regression identified predictors of treatment failure. Longitudinal FiO₂ trajectories were analysed using linear mixed-effects models.
RESULTS: n = 96 infants were included; at treatment initiation, on a median postnatal age of 19 days (IQR 14-24) and FiO₂ 0.40 (IQR 0.35-0.50), 31 (32%) received non-invasive ventilation. Treatment failure occurred in 32 infants (33%). Initiation during non-invasive respiratory support was independently associated with lower odds of treatment failure (aOR 0.34; 95% CI 0.12-0.99; p = 0.049). FiO₂ trajectories diverged from day 3 onward, remaining higher in infants with treatment failure. In survivors to 36 weeks postmenstrual age, treatment failure was strongly associated with severe BPD (OR 6.7; 95% CI 2.2-20.0; p = 0.01).
CONCLUSION: Approximately two-thirds of preterm infants showed short-term respiratory improvement following hydrocortisone treatment. Treatment success was more frequently observed when hydrocortisone was initiated during non-invasive respiratory support. Early divergence in FiO₂ trajectories distinguished treatment success from failure and may serve as a pragmatic marker of short-term treatment response. Treatment failure was associated with adverse pulmonary outcome. These findings are hypothesis-generating and warrant further study.
METHODS: Retrospective single-centre cohort study including infants born at 240-296 weeks' gestation (2013-2023) who received a standardized hydrocortisone course (cumulative dose 72.5 mg/kg) to facilitate extubation or avoid intubation. Treatment failure at day 21 was defined as death, ongoing mechanical ventilation, FiO₂ ≥ 0.40, inability to taper hydrocortisone according or escalation to dexamethasone. Logistic regression identified predictors of treatment failure. Longitudinal FiO₂ trajectories were analysed using linear mixed-effects models.
RESULTS: n = 96 infants were included; at treatment initiation, on a median postnatal age of 19 days (IQR 14-24) and FiO₂ 0.40 (IQR 0.35-0.50), 31 (32%) received non-invasive ventilation. Treatment failure occurred in 32 infants (33%). Initiation during non-invasive respiratory support was independently associated with lower odds of treatment failure (aOR 0.34; 95% CI 0.12-0.99; p = 0.049). FiO₂ trajectories diverged from day 3 onward, remaining higher in infants with treatment failure. In survivors to 36 weeks postmenstrual age, treatment failure was strongly associated with severe BPD (OR 6.7; 95% CI 2.2-20.0; p = 0.01).
CONCLUSION: Approximately two-thirds of preterm infants showed short-term respiratory improvement following hydrocortisone treatment. Treatment success was more frequently observed when hydrocortisone was initiated during non-invasive respiratory support. Early divergence in FiO₂ trajectories distinguished treatment success from failure and may serve as a pragmatic marker of short-term treatment response. Treatment failure was associated with adverse pulmonary outcome. These findings are hypothesis-generating and warrant further study.