Key Takeaways
- Early hydrocortisone treatment enhances survival chances for extremely premature infants without lung disease.
- The study confirms the treatment’s safety with no increased risk of severe side effects.
- Potential long-term benefits on brain development are being investigated in future research.
Breakthrough in Neonatal Care
A recent study from Linköping University reveals that early hydrocortisone treatment can significantly improve the survival rates of extremely premature infants—those born before 28 weeks—while minimizing the risk of developing bronchopulmonary dysplasia (BPD). This finding is particularly noteworthy as BPD can lead to lifelong health issues, including increased susceptibility to infections and impaired brain development.
BPD occurs because the lungs of extremely premature infants are often underdeveloped. Inflammation plays a principal role in damaging lung tissue. Infants born this early struggle to produce sufficient cortisone, a hormone known to suppress inflammation. This has prompted research into hydrocortisone as a preventive treatment.
While earlier studies have shown promising results, concerns about potential severe side effects have made treatment controversial. In Sweden, varying guidelines have resulted in “natural experiments” where some regions administer hydrocortisone from the first day after birth, while others refrain from its use. This study capitalizes on this situation, analyzing real-world data from Sweden, a notable contribution given the scarcity of similar studies globally.
The research team examined data from the national neonatal registry, comparing 474 children who received hydrocortisone with 632 children born in the same region prior to its introduction, along with those from regions without the treatment. All participants were born between 22 and 27 weeks of gestation between 2018 and 2023.
The findings indicate that early hydrocortisone administration significantly enhances the likelihood of surviving without lung disease. Veronica Smedbäck, a PhD student involved in the study, confirmed the treatment’s safety, stating that it does not increase the risk of severe complications during the newborn stage.
BPD not only affects immediate health but also leads to long-term challenges such as difficulties in gaining weight and negative impacts on cognitive and physical development. As more than half of extremely premature babies are affected by this condition, the implications of this treatment could extend to a considerable population of vulnerable infants, potentially lessening long-term care needs for families and healthcare systems.
Moving forward, while the initial safety outcomes of the treatment are encouraging, researchers are now focused on examining its long-term effects, particularly concerning brain development. Preliminary evidence suggests potential benefits in this area, but further studies are essential to draw definitive conclusions.
The study was supported by the Joanna Cocozza Foundation for Child Medical Research and an ALF research grant from Region Östergötland. The complete findings are published in JAMA Network Open and shed light on a promising approach to improve the outcomes for extremely premature infants.
Article Title: Early prophylactic hydrocortisone, broncopulmonary dysplasia, and survival in extremely preterm infants
Authors: Veronica Smedbäck, Lars Björklund, Anders Flisberg, Jolanta Wróblewska, Olivier Baud, Erik Wejryd, and Ulrika Ådén
Publication: JAMA Network Open, February 19, 2026
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