A large, randomised control trial, the PREMILOC trial, has established that giving low dose hydrocortisone prophylactically in the first ten days of life reduces the risk of bronchopulmonary dysplasia in babies born before 32 weeks' gestation. However, the PREMILOC trial was underpowered to investigate rarer side effects, such as gastrointestinal perforation. This study aims to establish whether the odds of gastrointestinal perforation increase when extremely preterm infants are given prophylactic hydrocortisone in the first ten days of life. This retrospective cohort study will use routinely collected data from the U.K. National Neonatal Research Database. The investigators will examine the records of all infants born before 28 weeks' gestation and cared for in English and Welsh neonatal units between 2016 and 2023. Infants will be considered exposed if they received hydrocortisone for at least eight consecutive days, beginning on postnatal day 1 or 2. The primary outcome will be gastrointestinal perforation, as recorded in the infant's neonatal unit record. This outcome will be validated with the original care teams for a sample of babies. Data will be analysed using a propensity score matched approach to reduce the impact of confounding.
Study Type
OBSERVATIONAL
Enrollment
16,000
Cohort members will be considered to be exposed to early hydrocortisone if either: 1. They receive early hydrocortisone started on postnatal day 1 or 2 and given for more than seven consecutive days OR 2. They receive early hydrocortisone started on postnatal day 1 or 2 and are being cared for in a PROHYDRO unit but die on or before postnatal day 8. PROHYDRO units are defined as units who, at the time the baby was born, had implemented a protocol for use of prophylactic hydrocortisone as part of routine care for babies born less than 28 weeks' gestation. A unit may change from being a non-PROHYDRO unit to a PROHYDRO unit if a new early hydrocortisone protocol is introduced during the study period (2016-2023).
Imperial College
London, United Kingdom
Gastrointestinal (GI) perforation
A baby will be considered to have had a gastrointestinal perforation if their National Neonatal Research Database record includes a record of a GI perforation in the diagnoses field.
Time frame: From date of birth until day 14 of life
Survival without gastrointestinal perforation
Baby survived to discharge from neonatal unit without a gastrointestinal perforation
Time frame: From date of birth until the date of discharge from final neonatal unit, assessed up to 24 months
Mortality before discharge home
Baby died before discharge from neonatal unit
Time frame: From date of birth until the date of discharge from final neonatal unit, assessed up to 24 months
Total length of stay
Length of stay in neonatal care
Time frame: From date of birth until the date of discharge from final neonatal unit, assessed up to 24 months
Proportion of days on unit being mechanically ventilated
Time frame: From date of birth until the date of discharge from final neonatal unit, assessed up to 24 months
Bronchopulmonary dysplasia
any respiratory or ventilatory support or supplemental oxygen at 36 weeks' postmenstrual age (PMA)
Time frame: From date of birth until 36 weeks' postmenstrual age (PMA)
Bronchopulmonary dysplasia
Using an adapted Jensen criteria based on the highest level of respiratory support at 36 weeks PMA
Time frame: From date of birth until 36 weeks' postmenstrual age (PMA)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.