A retrospective study of 37 preterm neonates found no statistically significant difference between hydrocortisone and dexamethasone in preventing death or bronchopulmonary dysplasia (BPD) when administered during the second postnatal week. The primary composite outcome of death or BPD at 36 weeks postmenstrual age occurred in 22.2% of the hydrocortisone group and 10.5% of the dexamethasone group.
The exploratory research, conducted in a tertiary-care neonatal intensive care unit in western India, aimed to resolve the lack of head-to-head comparisons between these two corticosteroids. Researchers reviewed records of infants born at or before 34 weeks of gestation who remained dependent on respiratory support during their second week of life.
Clinicians choose steroid doses for neonates
The study grouped neonates based on the agent chosen by their treating neonatologist. Hydrocortisone was administered at 1 mg/kg/day for seven days, followed by 0.5 mg/kg/day for three days. Dexamethasone followed a low-dose regimen with a cumulative dose of 0.89 mg/kg over 10 days.
Both groups received the therapy for a total of 10 days. The researchers noted that the choice of drug was left to individual clinicians because the unit lacked a written protocol favoring one agent over the other.
Did you know? BPD persists largely because of the improved survival of the most immature infants, in whom ventilator-induced injury, prolonged oxygen exposure, sepsis and inflammation interact.
Dexamethasone group shows shorter ventilation duration
Data showed that 73.7% of the dexamethasone group and 66.7% of the hydrocortisone group were weaned from oxygen support. Weaning from the entry mode of ventilation occurred in both the dexamethasone and hydrocortisone groups.
The total duration of ventilation was shorter for those receiving dexamethasone, averaging 15.8 days compared to 19.1 days for the hydrocortisone group. However, the researchers cautioned that this finding was nominal and did not remain significant after Bonferroni correction for multiple comparisons.
| Outcome at 36 Weeks PMA | Hydrocortisone (n=18) | Dexamethasone (n=19) |
|---|---|---|
| Death or BPD (Composite) | 22.2% | 10.5% |
| BPD Only | 16.7% | 0% |
| Death Only | 5.6% | 10.5% |
Adverse events remain comparable between treatments
The frequency of adverse events remained comparable between the two treatment arms.
Small sample size limits study findings
The cohort consisted of neonates admitted between October 2022 and April 2024. The researchers acknowledged substantial limitations, including a small sample size and a retrospective design. The 95% confidence interval for the primary risk difference ranged from -12.0% to 35.3%, meaning the study cannot claim equivalence or non-inferiority.
Corticosteroid efficacy questions
Does this mean dexamethasone is better for preventing BPD?
No. While BPD occurred in 0% of the dexamethasone group versus 16.7% of the hydrocortisone group, the difference was not statistically significant due to the small sample size.
Were there more side effects with one drug over the other?
No. The frequency of each short-term adverse event was comparable between the two groups.
Can these results be applied to all preterm infants?
The researchers stated these findings are hypothesis-generating and require confirmation in larger, randomized trials with long-term neurodevelopmental follow-up.
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