The Efficacy of Hydrocortisone in Preventing Bronchopulmonary Dysplasia: An Integrative Literature Review

Abstract

Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects mostly premature neonates, its pathophysiology is still uncertain, proliferative, apoptotic, and proinflammatory mechanisms are linked. The use of corticosteroids is an option in an attempt to prevent BPD. Objective: This literature review seeks to understand whether hydrocortisone has benefits in preventing BPD in preterm neonates. Methodology: An integrative review was carried out using Medline / Pubmed, Biblioteca Virtual da Saude (BVS), Cochrane, EMBASE, and Scielo as databases, searching for articles, between 2015 and 2021, that used only hydrocortisone for the prevention of BPD. To assess the methodological and evaluation quality, AMSTAR criteria, and GRADE system were used respectively. Results: From a total of 194 articles, 5 were included in the study, 2 studies observed a decrease in the need for mechanical ventilation, 3 had a decreased mortality rate and in 2 studies the cases of BPD were reduced with the use of hydrocortisone. One study did not show statistical significance for either mortality or BPD prevention with drug use compared with placebo. These studies showed a reduction in the need for invasive mechanical ventilation, as well as an increase in the extubation rate. The death rate for newborns who used hydrocortisone was also lower compared to the control group. Regarding the prevention of BPD, hydrocortisone showed a slight reduction in the number of cases compared to placebo, when started early (<24 hours) and with a low dose. Conclusion: The use of low-dose and early-onset of hydrocortisone was superior to placebo in preventing BPD, but hydrocortisone is still not an ideal drug for preventing BPD.