***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Dexamethasone treatment is associated with an increased risk of cerebral palsy ( CP ) . Early hydrocortisone ( HC ) treatment may decrease the incidence of bronchopulmonary dysplasia ; however , the long-term effects are still under evaluation . Follow-up of r and omized studies concerning early HC treatment is essential to confirm the long-term safety . Objective : We hypothesized that early HC treatment in very preterm infants does not impair the neurologic outcome . Methods : We report follow-up data from a r and omized trial of early HC given for 10 days . Before the HC or placebo treatment , serum cortisol levels were measured . Receiver-operating characteristic was defined . Values below the median were classified as low endogenous cortisol and those above the median as high endogenous cortisol . A meta- analysis was performed . Results : Altogether 98 % of the 46 surviving infants participated in a follow-up study at a corrected age of 2 years . The growth characteristics were similar between the study groups . The developmental quotients ( DQs ) of the children with high endogenous cortisol and placebo treatment shortly after birth ( 100 ± 13 ) and those with low endogenous cortisol and HC ( 97 ± 7 ) were not lower than the DQs of the children with high endogenous cortisol and HC ( 92 ± 3 ) or low cortisol and placebo ( 96 ± 2 ) . According to a meta- analysis of three available trials ( 411 children ) , the rate of CP and survival without neurosensory or cognitive impairment was not influenced by HC . Conclusion : Early low-dose HC administration had no adverse effects at 2 years of age . Further studies are required to define the target group for neonatal HC We evaluated the neurodevelopment and growth of five‐ to seven‐year‐old children who had participated in a r and omised trial of early low‐dose hydrocortisone treatment to prevent bronchopulmonary dysplasia BACKGROUND . Low cortisol concentrations in premature infants have been correlated with increased severity of illness , hypotension , mortality , and development of bronchopulmonary dysplasia . A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a r and omized , multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia . Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisone-treated  patients exposed to chorioamnionitis .  We now report outcomes at 18 to 22 months ' corrected age . PATIENTS AND METHODS . Surviving infants were evaluated with st and ardized neurologic examination and Bayley Scales of Infant Development-II . Neurodevelopmental impairment was defined as a Mental Developmental Index or Psychomotor Developmental Index of < 70 , cerebral palsy , blindness or deafness . RESULTS . A total of 252 ( 87 % ) of 291 survivors were evaluated .  Cerebral palsy was diagnosed in 13 % of hydrocortisone-treated versus 14 % of placebo-treated infants . Fewer hydrocortisone-treated infants had a Mental Development Index < 70 , and more of the hydrocortisone-treated infants showed evidence of awareness of object permanence . Incidence of neurodevelopmental impairment was not different ( 39 % [ hydrocortisone ] vs 44 % [ placebo ] ) . There were no differences in physical growth measures . Chorioamnionitis-exposed infants treated with hydrocortisone were shorter and weighed less than controls but had no evidence of neurodevelopmental impairment . Among infants not exposed to chorioamnionitis , hydrocortisone-treated patients were less likely to have a Mental Development Index of < 70 or to be receiving glucocorticoids at follow-up . CONCLUSIONS . Early , low-dose hydrocortisone treatment was not associated with increased cerebral palsy . Treated infants had indicators of improved developmental outcome . Together with the short-term benefit previously reported , these data support additional studies of hydrocortisone treatment of adrenal insufficiency in extremely premature infants BACKGROUND Early administration of high doses of dexamethasone may reduce the risk of  chronic lung disease in premature infants but can cause complications . Whether moderate doses would be as effective but safer is not known . METHODS We r and omly assigned 220 infants with a birth weight of 501 to 1000 g who were treated with mechanical ventilation within 12 hours after birth to receive dexamethasone or placebo with either routine ventilatory support or permissive hypercapnia . The dexamethasone was administered within 24 hours after birth at a dose of 0.15 mg per kilogram of body weight per day for three days , followed by a tapering of the dose over a period of seven days . The primary outcome was death or chronic lung disease at 36 weeks ' postmenstrual age . RESULTS The relative risk of death or chronic lung disease in the dexamethasone-treated infants , as compared with those who received placebo , was 0.9 ( 95 percent confidence interval , 0.8 to 1.1 ) . Since the effect of dexamethasone treatment did not vary according to the ventilatory approach , the two dexamethasone groups and the two placebo groups were combined . The infants in the dexamethasone group were less likely than those in the placebo group to be receiving oxygen supplementation 28 days after birth ( P=0.004 ) or open-label dexamethasone ( P=0.01 ) , were more likely to have hypertension ( P<0.001 ) , and were more likely to be receiving insulin treatment for hyperglycemia ( P=0.02 ) . During the first 14 days , spontaneous gastrointestinal perforation occurred in a larger proportion of infants in the dexamethasone group ( 13 percent , vs. 4 percent in the placebo group ; P=0.02 ) . The dexamethasone-treated infants had a lower weight ( P=0.02 ) and a smaller head circumference ( P=0.04 ) at 36 weeks ' postmenstrual age . CONCLUSIONS In preterm infants , early administration of dexamethasone at a moderate dose has no effect on death or chronic lung disease and is associated with gastrointestinal perforation and decreased growth Importance Dexamethasone to prevent bronchopulmonary dysplasia in very preterm neonates was associated with adverse neurodevelopmental events . Early low-dose hydrocortisone treatment has been reported to improve survival without bronchopulmonary dysplasia but its safety with regard to neurodevelopment remains to be assessed . Objective To assess whether early hydrocortisone therapy in extremely preterm infants is associated with neurodevelopmental impairment at 2 years of age . Design , Setting , and Participants An exploratory secondary analysis of the PREMILOC ( Early Low-Dose Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia in Extremely Preterm Infants ) r and omized clinical trial conducted between 2008 and 2014 in 21 French neonatal intensive care units . R and omization was stratified by gestational age groups . Neurodevelopmental assessment s were completed from 2010 to 2016 . Interventions After birth , patients were r and omly assigned to receive placebo or hydrocortisone ( 0.5 mg/kg twice per day for 7 days , followed by 0.5 mg/kg per day for 3 days ) . Main Outcomes and Measures The prespecified exploratory secondary outcome of neurodevelopmental impairment was based on a st and ardized neurological examination and the revised Brunet-Lézine scale ( global developmental quotient score and subscores ; mean norm , 100 [ SD , 15 ] ) . The minimal clinical ly important difference on the global developmental quotient was 5 points . Results Of 1072 neonates screened , 523 were assigned to hydrocortisone ( n = 256 ) or placebo ( n = 267 ) and 406 survived to 2 years of age . A total of 379 patients ( 93 % ; 46 % female ) were evaluated ( 194 in the hydrocortisone group and 185 in the placebo group ) at a median corrected age of 22 months ( interquartile range , 21 - 23 months ) . The distribution of patients without neurodevelopmental impairment ( 73 % in the hydrocortisone group vs 70 % in the placebo group ) , with mild neurodevelopmental impairment ( 20 % in the hydrocortisone group vs 18 % in the placebo group ) , or with moderate to severe neurodevelopmental impairment ( 7 % in the hydrocortisone group vs 11 % in the placebo group ) was not statistically significantly different between groups ( P = .33 ) . The mean global developmental quotient score was not statistically significantly different between groups ( 91.7 in the hydrocortisone group vs 91.4 in the placebo group ; between-group difference , 0.3 [ 95 % CI , −2.7 to 3.4 ] ; P = .83 ) . The incidence of cerebral palsy or other major neurological impairments was not significantly different between groups . Conclusions and Relevance In this exploratory analysis of secondary outcomes of a r and omized clinical trial of extremely preterm infants , early low-dose hydrocortisone was not associated with a statistically significant difference in neurodevelopment at 2 years of age . Further r and omized studies are needed to provide definitive assessment of the neurodevelopmental safety of hydrocortisone in extremely preterm infants . Trial Registration clinical trials.gov Identifier : OBJECTIVES To investigate the effect of hydrocortisone treatment on  survival without bronchopulmonary dysplasia ( BPD )  and to study whether serum cortisol concentrations predict the response . STUDY DESIGN We performed a r and omized , placebo-controlled trial on infants with gestation < or = 30 weeks , body weight of 501 to 1250 g , and respiratory failure .  Hydrocortisone was started before 36 hours of age and given for 10 days at doses from 2.0 to 0.75 mg/kg per day . Shortly before hydrocortisone treatment , basal and stimulated ( ACTH , 0.1 microg/kg ) serum cortisols were measured . RESULTS The study was discontinued early , because of gastrointestinal perforations in the hydrocortisone group ( 4/25 vs 0/26 , P = .05 ) ; 3 of the 4 had received indomethacin/ibuprofen . The incidence of BPD ( 28 % vs placebo 42 % , P = 0.28 ) tended to be lower , and patent ductus arteriosus ( 36 % vs 73 % , P = .01 ) was lower in the hydrocortisone group . The hydrocortisone-treated infants with serum cortisol concentrations above the median had a high risk of gastrointestinal perforation . In infants with cortisol values below the median , hydrocortisone treatment increased survival without BPD . CONCLUSIONS Serum cortisol concentrations measured shortly after birth may identify those very high-risk infants who may benefit from hydrocortisone supplementation Objective . To assess the effectiveness of a “ stress dose ” of hydrocortisone for rescue treatment of refractory hypotension and adrenocortical insufficiency of prematurity in very low birth weight ( VLBW ) infants . We hypothesized that significantly more VLBW infants who were receiving dopamine ≥10 μg/kg per min could wean off vasopressor support 72 hours after treatment with hydrocortisone . Methods . A double-blind , r and omized , controlled study was conducted in a university neonatal center . Forty-eight VLBW infants who had refractory hypotension and required dopamine ≥10 μg/kg per min were r and omly assigned to receive a stress dose of hydrocortisone ( 1 mg/kg every 8 hours for 5 days ; n = 24 ) or an equivalent volume of the placebo solution ( isotonic saline ; n = 24 ) . Results . The baseline clinical characteristics were similar between the groups . Serum cortisol concentrations were very low immediately before r and omization in both groups of infants . Significantly more VLBW infants who were treated with hydrocortisone weaned off vasopressor support 72 hours after starting treatment . The use of volume exp and er , cumulative dose of dopamine , and dobutamine were significantly less in hydrocortisone-treated infants compared with control infants . In addition , the median duration of vasopressor treatment was halved in hydrocortisone-treated patients . Two versus 11 infants in the hydrocortisone and control groups required a second vasopressor for treatment of refractory hypotension . The trend ( linear and quadratic ) of the mean arterial blood pressure was also significantly and consistently higher in hydrocortisone-treated infants . Conclusions . A stress dose of hydrocortisone was effective in treating refractory hypotension in VLBW infants . Although routine and prophylactic use of systemic corticosteroids could not be recommended because of their potential adverse effects , this relatively low dose of hydrocortisone would probably be preferable to high-dose dexamethasone for treatment of ref 
    Output:
    
Conclusion : Early systemic hydrocortisone is a modestly effective therapy for the prevention of BPD in preterm infants , although some safety concerns remain .
No conclusions could be drawn for late hydrocortisone due to the paucity of studies .What is Known:• Preterm infants are at high risk of developing bronchopulmonary dysplasia ( BPD ) and early lung inflammation plays a significant role in its pathogenesis.• Both early and late systemic dexamethasone seems to reduce the incidence of BPD , but its use is associated with serious neurodevelopmental impairment at follow-up .
What is New:• Early systemic hydrocortisone significantly improved survival without BPD at 36 weeks and survival without moderate to severe neurodevelopmental impairment on follow up.• Incidence of gastrointestinal perforation associated with concurrent treatment for PDA was significantly higher , although early systemic hydrocortisone reduced the need for treatment of PDAs