Endocrine Abstracts

Background: Prophylactic low dose hydrocortisone in extremely preterm neonates (<28 weeks) is increasingly used to reduce bronchopulmonary dysplasia (BPD), yet its impact on the developing hypothalamic–pituitary–adrenal (HPA) axis is uncertain.

Methods: A systematic review was registered with PROSPERO (CRD42025640878). PubMed, Scopus, Cochrane Library and Google Scholar were searched from inception to April 2025 using terms related to prematurity, hydrocortisone, cortisol and HPA axis. Two reviewers independently screened titles, abstracts and full texts; a third independent reviewer resolved decisions when consensus was not reached. The primary outcome was biochemical or clinical evidence of adrenal insufficiency after hydrocortisone therapy use in the ex-preterm (<37 weeks) neonate.

Results: Of 993 records, 821 remained after duplicate removal. 36 full text articles were assessed. 23 studies were excluded for evaluating dexamethasone (n = 17) or inhaled corticosteroids (n = 5); 11 lacked HPA outcomes. Three studies remained. Two did not directly assess adrenal insufficiency (Romjin 2023, Takayanagi 2015). The single eligible manuscript (Rosano 2024) measured random plasma cortisol concentrations after hydrocortisone therapy to determine the utility of cortisol in the assessment of adrenal insufficiency, however dynamic testing was not performed on all patients and therefore diagnosis of patients was not uniform.

Conclusion: No contemporary study rigorously evaluates the short or long term effect of prophylactic low dose hydrocortisone on adrenal function in preterm infants. Given the expanding use of prophylactic hydrocortisone to prevent BPD, high quality prospective trials incorporating appropriate assessment of the HPA axis are required.

References: 1. Romijn M, et al Pediatr Res. 2023.2. Rosano K, et al. J Perinatol. 2024.3. Takayanagi T, et al Acta Paediatr. 2015.