TOPLINE:

Premature infants who received hydrocortisone treatment for the prevention of bronchopulmonary dysplasia did not show any differences in rates of delays in cognitive, motor, or academic performance during early childhood compared with those who received placebo. However, children receiving hydrocortisone had lower body weights than those receiving placebo.

METHODOLOGY:

• Researchers conducted a prospective outcomes follow-up study of the hydrocortisone for bronchopulmonary dysplasia trial at 19 clinical centers across the US to evaluate the effects of neonatal hydrocortisone treatment in premature infants who were at high risk for bronchopulmonary dysplasia on functional outcomes during childhood.
• Intubated infants born before 30 weeks’ gestation from 2011 to 2018 were randomly assigned to receive either a 10-day tapering course of hydrocortisone or a placebo starting at 14-28 postnatal days.
• Participants who survived to early school age were evaluated during visits conducted from 2017 to 2024; participants comprised 272 children in the hydrocortisone group (mean age at follow-up, 5.3 years; 55.9% girls) and 273 in the placebo group (mean age at follow-up, 5.4 years; 39.6% girls).
• The primary outcome was functional impairment, defined as the presence of at least one of the following: delays in cognitive, motor, or academic performance or poor functional exercise capacity. Secondary outcomes included the individual components of the primary outcome.

TAKEAWAY:

• No significant difference in the functional impairment rate was observed between hydrocortisone (71.3%) and placebo (73.3%) groups at early school age (adjusted relative risk, 0.99; 95% CI, 0.89-1.10).
• The study found no significant differences in the rates of cognitive, motor, or academic delays or poor functional exercise capacity between the two groups.
• Children in the hydrocortisone group had a lower mean weight than those in the placebo group (19.7 kg vs 20.7 kg) and were less likely to have a BMI above the 90th percentile (12.1% vs 20.7%).

IN PRACTICE:

“[T]he current study demonstrates lack of measurable benefits for school-age functional outcomes, but it also provides reassurance regarding the long-term safety profile of hydrocortisone in these patients,” the authors of the study wrote. “[T]his study demonstrates that the hydrocortisone regimen evaluated in this trial should not be used to prevent BPD [bronchopulmonary dysplasia] or to improve long-term functional outcomes of ventilated, very preterm infants.”

SOURCE:

This study was led by Sara B. DeMauro, MD, MSCE, of the Children’s Hospital of Philadelphia in Philadelphia. It was published online on December 8, 2025, in JAMA Pediatrics.

LIMITATIONS:

The narrow inclusion criteria and low consent rate may affect the applicability of the findings to a broader population.

DISCLOSURES:

The study was supported by grants from the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Sciences, among other organizations. One of the authors reported being a co-founder of and having equity in Thrive Neuromedical.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.