Because intrauterine and/or early postnatal inflammation play(s) an important role in the pathogenesis of bronchopulmonary dysplasia (BPD) early administration of anti-inflammatory therapy to high-risk preterm newborns is theoretically substantiated. In a randomised study we evaluated the clinical effectiveness of early administration of caffeine and hydrocortisone to very preterm newborns that required mechanical ventilation (MV) shortly after birth.
Methods 120 very low birth weight newborns (gestational age < 32 wks.) on MV were randomly assigned on the first day of life to one of the 2 groups depending on administration of caffeine and hydrocortisone. 60 infants with gestational age of 28.02 (1.9) wks. were treated with caffeine (20/5 mg/kg/day) and hydrocortisone (1 mg/kg/day) for 12 days. 60 babies with gestational age of 28.4 (1.8) wks. in the control group were managed according to standard guidelines. The primary study outcome was the incidence of mortality and BPD at 36 weeks’ corrected age. BPD was defined according to the NIH consensus definition in modification of Walsh et al. (2003).
Results BPD developed in 19 (35%) infants treated with caffeine and hydrocortisone and in 20 (37%) babies from the control group (p>0.05). The composite outcomes (death plus BPD) (26 [43%] vs. 27 [45%] accordingly; p>0.05) and incidences of severe BPD were not different between the groups either. Early anti-inflammatory therapy reliably facilitated extubation but did not reduce the duration of the initial period of MV.
Conclusions Early administration of caffeine and hydrocortisone did not prevent BPD development in very preterm newborns requiring MV.