At-a-Glance
Postnatal hydrocortisone for BPD prevention: A 10-day hydrocortisone taper given at 14-28 days of life in ventilated preterm infants did not significantly impact functional outcomes at early school age compared with placebo.¹
Neonatal pharmacokinetics: Preterm neonates may be 80-90% total body water. Neonates therefore require higher weight-based doses of gentamicin, a water-soluble drug, compared to older patients to achieve adequate serum concentrations.
Pediatric anesthesia safety guidance: Updated AAP policy outlines medication safety protocols and facility readiness standards for pediatric sedation and anesthesia environments.²
New & Notable
In a follow-up of a randomized clinical trial of very preterm infants (< 30 weeks’ gestation), functional impairment at early school age occurred in 71.3% of children who received hydrocortisone compared to 73.3% who received placebo (adjusted relative risk 0.99; 95% CI 0.89-1.10). Functional impairment included cognitive delay, motor delay, academic delay, or poor exercise capacity at a mean corrected age of 5.4 years. Motor delay occurred in 60.4% of children and poor exercise capacity in 36.2%.
Cognitive, academic, and motor assessments showed no meaningful differences between hydrocortisone and placebo groups across individual domains.
Children exposed to hydrocortisone had slightly lower mean body weight at follow-up (19.7 kg vs 20.7 kg) and were less likely to have a body mass index above the 90th percentile (12.1% vs 20.7%). Other anthropometric and cardiopulmonary measures were similar.
This study provides evidence that a 10-day hydrocortisone taper started at 2-4 weeks of life for prevention of BPD in intubated, very preterm infants does not cause long-term harm at 5-7 years corrected age. Although it appears to be safe long-term, this specific regimen should not be used for BPD prevention, as short-term data showed a lack of benefit.¹
Clinical Pearl
Neonates Have More Space for Water-Soluble Drugs
Preterm neonates have a markedly different body composition than older children and adults. Total body water may account for up to 80-90% of body weight.
This larger aqueous compartment increases the distribution space for water-soluble medications like gentamicin. Clinically, this explains why neonates often require higher weight-based doses of certain water-soluble medications to achieve therapeutic concentrations.
The concept is demonstrated step-by-step in the video: Volume of Distribution: Clinical Application in Neonates
Pediatric Pulse
AAP Issues Updated Safety Guidance for Pediatric Periprocedural Anesthesia
The American Academy of Pediatrics released updated guidance describing the essential elements of a safe pediatric anesthesia environment. The policy emphasizes standardized concentrations for high-alert anesthetic medications and requires pediatric-ready emergency carts in any facility that administers sedation to children.
For pediatric clinicians, the update sets expectations for medication preparation, monitoring, and emergency readiness in settings ranging from hospital operating rooms to outpatient procedural suites.²
References
DeMauro SB, Kirpalani H, Hintz SR, et al. Hydrocortisone in preterm infants and school-age functional outcomes: follow-up of a randomized clinical trial. JAMA Pediatrics. 2026;180(2):134-143.
American Academy of Pediatrics. New safety data inform updated AAP policy on pediatric anesthesia environments. AAP News. 2026. https://publications.aap.org/aapnews/news/34348/New-safety-data-inform-updated-AAP-policy-on
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— Dr. Su