Presumed adrenal insufficiency in neonates treated with corticosteroids for the prevention of bronchopulmonary dysplasia

J Perinatol. 2022 Jan;42(1):65-71. doi: 10.1038/s41372-021-01251-y. Epub 2021 Nov 1.


Objective: To determine if extremely preterm (EPT) neonates receiving dexamethasone for the prevention of BPD have a higher incidence of presumed adrenal insufficiency (PAI).

Study design: Retrospective cohort study of neonates <28 weeks gestation examining PAI after dexamethasone use and PAI after intratracheal budesonide with surfactant administration.

Result: Of 332 neonates, 38% received dexamethasone. The incidence of PAI was higher in neonates who had received dexamethasone (20.8% vs 2.9%, p < 0.001). However, for intubated babies receiving surfactant, dexamethasone was not independently associated with increased PAI after adjusting for gestational age, birthweight, and race (aOR 2.92, 95% CI: 0.79-10.85). Dexamethasone was independently associated with increased PAI in infants previously receiving budesonide/surfactant treatment (aOR 5.38, 95% CI: 1.38-20.90).

Conclusion: The use of dexamethasone alone was not associated with increased PAI, when adjusted for prematurity-related factors. The combination of budesonide with dexamethasone was significantly associated with increased PAI.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adrenal Insufficiency* / chemically induced
  • Adrenal Insufficiency* / epidemiology
  • Adrenal Insufficiency* / prevention & control
  • Bronchopulmonary Dysplasia* / etiology
  • Budesonide / adverse effects
  • Dexamethasone / adverse effects
  • Humans
  • Infant
  • Infant, Newborn
  • Pulmonary Surfactants* / therapeutic use
  • Respiration, Artificial / adverse effects
  • Retrospective Studies
  • Surface-Active Agents / therapeutic use


  • Adrenal Cortex Hormones
  • Pulmonary Surfactants
  • Surface-Active Agents
  • Budesonide
  • Dexamethasone