{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:35:12Z","timestamp":1793039712393,"version":"4.5.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n In randomized trials, early prophylactic hydrocortisone improved survival without bronchopulmonary dysplasia (BPD) with few adverse effects in extremely preterm infants. Large scale implementation data are needed to evaluate clinical effects and safety.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between early prophylactic hydrocortisone and survival without BPD at 36 weeks\u2019 postmenstrual age (PMA) in extremely preterm infants in Sweden after guideline implementation and to assess treatment safety.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A national historical cohort study with prospectively collected data from the Swedish Neonatal Quality register from 4 Swedish centers where hydrocortisone prophylaxis was implemented. The study included infants born between 22 and 27 weeks\u2019 gestation between 2018 and 2023. Infants were divided into exposed and nonexposed groups according to the intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Hydrocortisone, 1 mg\/kg\/d, for the first 7 days of life, followed by 0.5 mg\/kg\/d from days 8 through 10.<\/jats:p>\n <\/jats:sec>\n \n Main outcomes and measures<\/jats:title>\n The primary outcome was survival without BPD at 36 weeks\u2019 PMA. A predefined statistical analysis plan with logistic regression was used to calculate unadjusted and adjusted odds ratios.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1106 infants (median [IQR] gestational age, 25 weeks, 6 days [24 weeks, 3 days to 27 weeks]; median [IQR] birth weight, 780 [610-964] g), 474 received hydrocortisone prophylaxis and 632 did not. Survival without BPD occurred in 154 of 474 exposed (32.5%) and 185 of 632 nonexposed (29.3%) infants (adjusted odds ratio, 1.62; 95% CI, 1.16-2.27). BPD occurred in 233 exposed (49.2%) and 345 nonexposed (54.6%) infants (adjusted odds ratio, 0.65; 95% CI, 0.49-0.86). Death before 36 weeks\u2019 PMA occurred in 87 exposed (18.4%) and 102 nonexposed (16.1%) infants. Late-onset bacterial infection was more common in exposed infants, but not significant after adjustment. No other severe neonatal morbidities differed significantly between the 2 groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n In this cohort study of extremely preterm infants, the introduction of prophylactic hydrocortisone was associated with increased survival without BPD, after adjusting for covariates. There was no significant increase in severe neonatal morbidities, except that late-onset bacterial infection was more common in the exposed group before adjustments.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.60146","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:30:11Z","timestamp":1773775811000},"page":"e2560146","source":"Crossref","is-referenced-by-count":7,"title":["Early Prophylactic Hydrocortisone and Bronchopulmonary Dysplasia\u2013Free Survival in Extremely Preterm Infants"],"prefix":"10.1001","volume":"9","author":[{"given":"Veronica","family":"Smedb\u00e4ck","sequence":"first","affiliation":[{"name":"Department of Biomedical and Clinical Sciences, Division of Children\u2019s and Women\u2019s health, Link\u00f6ping University, Link\u00f6ping, Sweden"},{"name":"Futurum, Ryhov County Hospital, J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars J.","family":"Bj\u00f6rklund","sequence":"additional","affiliation":[{"name":"Pediatrics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden"},{"name":"Department of Pediatric Surgery and Neonatology, Sk\u00e5ne University Hospital, Lund and Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Flisberg","sequence":"additional","affiliation":[{"name":"Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg, Sweden"},{"name":"The Queen Silvia Children\u2019s Hospital, Department of Neonatology, Region V\u00e4stra G\u00f6taland, Sahlgrenska University, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Wr\u00f3blewska","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Baud","sequence":"additional","affiliation":[{"name":"Obstetric, Perinatal, Paediatric and Life Course Epidemiology Team (OPPaLE), Center for Research in Epidemiology and StatisticS (CRESS), Institut national de la sant\u00e9 et de la recherche m\u00e9dicale (INSERM), Paris Cit\u00e9 University, Paris, France"},{"name":"Department of Neonatal Medicine and Neonatal Intensive Care Unit, FHU Prem\u2019IMPACT, Cochin Port-Royal University Hospital, Assistance Publique-H\u00f4pitaux de Paris, Paris Cit\u00e9 University, 75014, Paris, France"},{"name":"Paris Cit\u00e9 University, Neuro-Diderot, INSERM, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Wejryd","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences, Division of Children\u2019s and Women\u2019s health, Link\u00f6ping University, Link\u00f6ping, Sweden"},{"name":"Department of Pediatrics, Vrinnevi hospital, Norrk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"\u00c5d\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences, Division of Children\u2019s and Women\u2019s health, Link\u00f6ping University, Link\u00f6ping, Sweden"},{"name":"Department of Women\u00b4s and Children\u00b4s Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Neonatal Medicine, Astrid Lindgrens Children\u00b4s Hospital. 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