By Elodie Vaz | Published on March 5, 2026 | 3 min readIn 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.
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next: Impact of diaper changing frequency
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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.
