Objectives To clarify if systemic hydrocortisone, in protocols allowing to start it before the 15th day of life, prevents bronchopulmonary dysplasia (BPD) or other adverse outcomes in very preterm neonates, and to identify any possible effect size modifiers. Study design Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Additional analyses included meta-regressions and review of biological plausibility. Results Seven trials were included, they were of general good quality and accounted for a total of 2193 infants. Hydrocortisone treatment did not reduce BPD (risk ratio (RR) 0.84 (95% CI 0.64 to 1.04)), but heterogeneity was evident (I2=51.6%). The effect size for BPD is greatest for 10–12 days duration of treatment (β=0.032 (0.01), p=0.007) and tended to be greater in patients with chorioamnionitis (β=−1.5 (0.841), p=0.07). Hydrocortisone treatment may significantly reduce mortality (RR 0.75 (95% CI 0.59 to 0.91)), there is no heterogeneity (I2=0) and the reduction tended to be greater in males (β=−0.06 (0.03), p=0.07). Hydrocortisone may significantly reduce necrotising enterocolitis (NEC; RR 0.72 (95% CI 0.53 to 0.92)); there is neither heterogeneity (I2=0%) nor any effect size modifiers. Hydrocortisone did not affect other adverse outcomes of prematurity. Conclusions Systemic hydrocortisone may be considered, on a case-by-case evaluation, to reduce mortality and NEC, while it does not affect BPD. There are some potential effect size modifiers for mortality and BPD which should be addressed in future explanatory trials. PROSPERO registration number CRD42023400520. Data are available on reasonable request. Raw data are available from the authors on reasonable request.

中文翻译：

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氢化可的松在极早产新生儿中预防 BPD：荟萃分析和效应量修正

目的 澄清方案中允许在出生后第 15 天之前开始使用全身性氢化可的松是否可以预防早产新生儿的支气管肺发育不良 (BPD) 或其他不良后果，并确定任何可能的效应大小调节剂。研究设计 按照系统评价和荟萃分析指南的首选报告项目进行系统评价和荟萃分析。其他分析包括元回归和生物学合理性审查。结果纳入7项试验，共纳入2193名婴儿，质量总体良好。氢化可的松治疗并未降低 BPD（风险比 (RR) 0.84（95% CI 0.64 至 1.04）），但异质性很明显 (I2=51.6%)。BPD 的效应大小在 10-12 天的治疗期间最大（β=0.032 (0.01), p=0.007），并且在绒毛膜羊膜炎患者中往往更大（β=-1.5 (0.841), p=0.07）。氢化可的松治疗可显着降低死亡率（RR 0.75（95% CI 0.59 至 0.91）），不存在异质性（I2=0），并且男性的死亡率降低幅度更大（β=-0.06 (0.03)，p=0.07） 。氢化可的松可显着减少坏死性小肠结肠炎（NEC；RR 0.72（95% CI 0.53 至 0.92））；既不存在异质性（I2=0%），也不存在任何效应大小调节剂。氢化可的松不影响早产的其他不良后果。结论 根据具体情况评估，可以考虑全身使用氢化可的松，以降低死亡率和 NEC，同时不影响 BPD。死亡率和 BPD 存在一些潜在的效应量修正因素，应在未来的解释性试验中解决。PROSPERO 注册号 CRD42023400520。可根据合理要求提供数据。原始数据可根据合理要求向作者提供。