Randomised trial of early neonatal hydrocortisone demonstrates potential undesired effects on neurodevelopment at preschool age

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>We evaluated the neurodevelopment and growth of five‐ to seven‐year‐old children who had participated in a randomised trial of early low‐dose hydrocortisone treatment to prevent bronchopulmonary dysplasia.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The 51 infants in the original study had birthweights of 501–1250 g and gestational ages of 23–30 weeks, required mechanical ventilation during the first 24 hours and received hydrocortisone or a placebo for 10 days. The majority (80%) of the 90% who survived to five‐ to seven years of age participated in this follow‐up study and their growth, neuromotor, cognitive and speech development were evaluated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Some neurodevelopment impairment was observed in 61% of the hydrocortisone group and 39% of the placebo group, ranging from minor neurological dysfunction to severe neurological conditions (p = 0.182). The mean full‐scale intelligence quotient (<jats:styled-content style="fixed-case">IQ</jats:styled-content>) was 87.8 (15.3) in the hydrocortisone group and 95.7 (15.0) in the placebo group (p = 0.135), and the mean performance <jats:styled-content style="fixed-case">IQ</jats:styled-content> was 88.3 (14.5) and 99.1 (14.0) (p = 0.034), respectively. A fifth (22%) of the hydrocortisone group required physiotherapy, but none of the placebo group did (p = 0.034). The age‐standardised growth was comparable between both groups.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Early hydrocortisone treatment may have undesired effects on neurodevelopment at preschool age, and further safety studies are required.</jats:p></jats:sec>