Prophylactic hydrocortisone and the risk of sepsis in neonates born extremely preterm

A 26-week gestational age male neonate, born vaginally, is admitted to the NICU. He has a history of perinatal asphyxia and is currently receiving standard supportive care. The neonatology team is considering initiating prophylactic low-dose hydrocortisone to reduce the risk of bronchopulmonary dysplasia and mortality. The parents inquire about the risk of late-onset sepsis associated with this treatment.

Based on the latest evidence from the PREMILOC trial re-analysis, what should the pharmacist counsel the healthcare team regarding the risk of late-onset sepsis (LOS) when using prophylactic low-dose hydrocortisone in this extremely preterm neonate?

Prophylactic hydrocortisone significantly increases the risk of late-onset sepsis and should be avoided in neonates with perinatal asphyxia.
Prophylactic hydrocortisone does not significantly increase the risk of late-onset sepsis after adjusting for perinatal risk factors, including perinatal asphyxia.
Hydrocortisone reduces the risk of late-onset sepsis but increases mortality in extremely preterm neonates.
The risk of late-onset sepsis is significantly higher with hydrocortisone only in neonates born by vaginal delivery.

A 24-week gestational age female neonate is admitted to the NICU with respiratory distress syndrome. The neonatology team is evaluating interventions to improve survival and reduce bronchopulmonary dysplasia. The pharmacist is asked about the evidence supporting the use of prophylactic low-dose hydrocortisone in this patient.

What is the most evidence-based statement regarding the effect of prophylactic low-dose hydrocortisone on mortality in extremely preterm neonates?

Prophylactic hydrocortisone has no effect on mortality but increases the risk of late-onset sepsis.
Prophylactic hydrocortisone significantly reduces mortality and bronchopulmonary dysplasia without significantly increasing late-onset sepsis risk.
Prophylactic hydrocortisone increases mortality but reduces bronchopulmonary dysplasia.
Prophylactic hydrocortisone reduces mortality only if administered after day 10 of life.

A 25-week gestational age neonate born via cesarean section is receiving supportive care in the NICU. The clinical pharmacist is reviewing risk factors for late-onset sepsis to optimize preventive strategies and is asked about modifiable and non-modifiable factors influencing LOS risk in this population.

According to the re-analysis of the PREMILOC trial, which of the following factors is independently associated with a lower risk of late-onset sepsis in extremely preterm neonates?

Cesarean delivery
Lower gestational age at birth
Administration of supplemental corticosteroids after day 10 but before LOS onset
Exposure to perinatal asphyxia

PACULit Literature Updates August 2025: Pediatrics

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Prophylactic hydrocortisone and the risk of sepsis in neonates born extremely preterm

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