Neonatal hydrocortisone: toward effective prevention of bronchopulmonary dysplasia in extremely preterm infants

By Elodie Vaz | Published on March 5, 2026 | 3 min read


In newborns born before 28 weeks of gestation, bronchopulmonary dysplasia (BPD) remains one of the most feared complications. More than half of these infants develop this chronic respiratory disease related to lung immaturity. Incomplete development of the alveoli and lung tissue, combined with postnatal insults, leads to long-term impairment of respiratory function. The consequences extend beyond the neonatal period: increased risk of infections and hospitalizations during childhood, poor weight gain, and negative effects on brain development.  

A central factor in the pathophysiology of BPD is pulmonary inflammation, which causes tissue injury and disrupts lung maturation. Cortisone, an anti-inflammatory hormone, attenuates this inflammatory response. However, extremely preterm infants do not produce sufficient amounts. While previous studies have suggested preventive benefits of hydrocortisone, they have also raised concerns about potential serious adverse effects.  

A study conducted by Linköping University and published on February 19 in JAMA Network Open now provides real-world clinical data. It suggests that early administration of hydrocortisone increases the likelihood of survival without pulmonary sequelae, while demonstrating short-term safety of the treatment.  

A swedish “natural experiment”  

In Sweden, some regions recently recommended hydrocortisone administration from the first day of life in extremely preterm infants, while others chose not to implement it.  

“This created a kind of natural experiment in Sweden, where some extremely preterm babies were treated and others were not. We took advantage of this situation in our study, in which we examined the effectiveness of this treatment in real-world care settings in Sweden. There are virtually no studies of this type in the world at present,” explained Ulrika Ådén, Professor of Pediatric Medicine at Linköping University and the Karolinska Institute, senior consultant in neonatology, and co-author of the study, in a press release.  

Analysis of the National Registry  

The researchers used data from the Swedish National Neonatal Quality Register. In total, 474 infants born between 22 and 27 weeks of gestation (2018–2023) who received hydrocortisone were compared with 632 infants born in the same region before the protocol was introduced. Analyses also included data from regions that did not offer the treatment.

This population-based approach made it possible to assess the effectiveness and safety of the treatment under real-world conditions, beyond the strict framework of randomized trials.  

Improved survival without BPD, no safety signal  

The results show a significant clinical benefit. “Our study shows that early administration of this treatment to extremely preterm infants increases their chances of survival without lung disease. Hydrocortisone treatment is safe and does not increase the risk of serious adverse effects in newborns,” said Veronica Smedbäck, doctoral student at Linköping University, physician, and co-author of the study, in a press release. The study focused on short-term safety and did not identify an increase in severe neonatal complications associated with hydrocortisone.  

Clinical implications and perspectives  

The potential impact of these findings is considerable. “Since more than half of extremely preterm infants develop this lung disease, this treatment could be valuable because it increases the chances of survival without the disease. Many countries are now saving extremely preterm infants; this treatment could therefore potentially concern a very large number of children,” emphasized Veronica Smedbäck.  
The authors nevertheless stress the need for long-term follow-up, particularly regarding neurodevelopment. Some studies suggest a positive effect of hydrocortisone in this respect, but additional data are required.  

By demonstrating, in real-world practice, the effectiveness and short-term safety of early hydrocortisone administration, this study paves the way for greater standardization of neonatal practices. It also raises the question of international harmonization of guidelines in a context where survival of extremely preterm infants is rapidly improving.        

Read next: Impact of diaper changing frequency on the skin microbiota of preterm infants

About the Author – Elodie Vaz
Health journalist, CFPJ graduate (2023).
Élodie explores the marks diseases leave on bodies and, more broadly, on human life. A registered nurse since 2010, she spent twelve years at patients’ bedsides before exchanging her stethoscope for a notebook. She now investigates the links between environment and health, convinced that the vitality of life cannot be reduced to that of human.