Association between prophylactic hydrocortisone and focal intestinal perforations in preterm infants born before 28 weeks gestation: an observational propensity matched population study in England and Wales
In brief
Early hydrocortisone was not linked to more bowel perforations in preterm infants
In a matched analysis of infants born before 28 weeks, focal intestinal perforations occurred in 4.9% of those given early hydrocortisone and 6.1% of those who were not, with no significant difference. Hydrocortisone use was associated with higher mortality, but this secondary finding from an observational study cannot establish cause and needs further investigation.
- Journal
- Archives of disease in childhood. Fetal and neonatal edition (Q1)
- Published
- 7 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Alice Sara Aveline, Alex Bottle, Anna Milan, Mireille Toledano, Sabita N Uthaya, Chris Gale, et al.
- PMID
- 42843981
- DOI
- 10.1136/archdischild-2026-330846
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 10 October 2026): Early hydrocortisone not associated with focal intestinal perforation
Abstract
OBJECTIVE: To examine the association between prophylactic hydrocortisone, given to prevent bronchopulmonary dysplasia, and the risk of focal intestinal perforation (FIP) in preterm infants. DESIGN: Retrospective cohort study using routinely-collected data from infants born between 2016 and 2023. SETTING: All English and Welsh neonatal units. PATIENTS: 15 746 infants born at less than 28 weeks gestation and admitted to a neonatal unit. Infants were matched (exposed vs unexposed) using a propensity score comprising 17 variables. EXPOSURE: Exposed infants received hydrocortisone for at least eight consecutive days beginning on postnatal day one or two. Unexposed infants did not receive hydrocortisone in line with this definition. MAIN OUTCOME MEASURES: Primary outcome was FIP. Secondary outcomes included mortality, survival without FIP, bronchopulmonary dysplasia. RESULTS: 6.3% (999/15 746) infants were exposed to early hydrocortisone and 4.6% (722/15 746) had FIP. 2815 infants (988 exposed and 1827 unexposed) were included in the matched analysis; 47% girls, median gestational age of 26.0 weeks (IQR 24.6-26.9) and median birth weight of 815 g (IQR 674-965). There was no significant difference in risk of FIP (4.9% (48/988) exposed vs 6.1% (111/1827) unexposed, OR 0.79, 95% CI 0.55 to 1.14); findings were consistent in the sensitivity analyses. Early hydrocortisone was associated with increased mortality (21.3% (210/988) exposed vs 16.2% (295/1827) unexposed, OR 1.40, 95% CI 1.14 to 1.72). CONCLUSIONS: Early prophylactic hydrocortisone from the first postnatal week was not associated with FIP. The observed association with higher mortality was a secondary finding in this observational study and requires cautious interpretation and further investigation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.