Research fellow Imperial College London, England, United Kingdom
Background: A large, randomised control trial (Baud et al 2016) has established that giving low dose hydrocortisone prophylactically in the first ten days of life reduces the risk of bronchopulmonary dysplasia (BPD) in babies born before 32 weeks gestation. However, the trial was underpowered to investigate rarer side effects, such as gastrointestinal perforation. Objective: This study aims to establish whether the odds of gastrointestinal perforation increase when extremely preterm infants are given hydrocortisone in the first ten days of life. Design/Methods: This retrospective cohort study used data from the U.K. National Neonatal Research Database. We examined the records of all infants born before 28 weeks gestation and treated in English and Welsh neonatal units between 2016 and 2023. Infants were considered to be exposed if they received hydrocortisone for at least eight consecutive days, beginning on postnatal day 1 or 2. 16,661 babies were included in the study of which 943 met the study definition of early hydrocortisone exposure. The primary outcome was gastrointestinal perforation, as recorded in the infant’s neonatal unit record. Results: Rates of gastrointestinal perforation were 5.3% in the hydrocortisone exposed group compared to 5.0% in the unexposed group. A propensity score matched analysis found no evidence of increased odds of gastrointestinal perforation in the group which were exposed early to hydrocortisone (aOR = 1.06, 95% CI = 0.69 - 1.62). The odds of bronchopulmonary dysplasia were not significantly different between the hydrocortisone exposed and unexposed groups (aOR = 1.07, 95% CI = 0.85 – 1.35).
Conclusion(s): Hydrocortisone given in the first ten days of life did not increase the odds of gastrointestinal perforation in this large sample of extremely premature infants. We are currently extending this study by validating the diagnoses of gastrointestinal perforation with the clinical care teams. We will also be examining different definitions of hydrocortisone exposure to help us differentiate between hydrocortisone given for different indications.
