Assessing the real-world effects of prophylactic hydrocortisone in the Canadian Neonatal Network: A cohort study.

OBJECTIVE

To evaluate the effects of prophylactic hydrocortisone (pHCT) on the odds of death or moderate to severe bronchopulmonary dysplasia (BPD) in preterm neonates.

STUDY

DESIGN

Multi-center retrospective cohort study of infants born <28 weeks in the Canadian Neonatal Network 2019-2023 who received pHCT with 1:1 propensity score-matched controls. Hierarchical composite endpoints were explored using win odds analyses.

RESULTS

There were 361 infants per group with balanced baseline characteristics. There were no differences in the odds of death or moderate to severe BPD (pHCT 259/361 [71.8%] vs. control 264/361 [73.1%], OR 0.92, 95% CI [0.68, 1.24]). Win odds (95% CI) were not different: 1.02 (0.85, 1.28). There was lower use of systemic postnatal steroids and treatment of patent ductus arteriosus in the pHCT group; no significant differences in other safety outcomes were observed.

CONCLUSIONS

pHCT was not associated with reductions in mortality nor moderate to severe BPD.