Prematurity Puzzle

“We have made a great deal of progress over the years in decreasing a number of problems of prematurity, but BPD does not seem to be going down,” Watterberg said. “In fact, it may be going up in incidence as we are saving smaller and smaller babies.”

In a study published in March in The New England Journal of Medicine (NEJM) Watterberg and her colleagues – more than a dozen doctors and researchers from several different hospitals around the country – attempted to treat the condition with the use of hydrocortisone, a steroidal anti-inflammatory drug.

The team conducted a trial involving 800 infants who had a gestational age of less than 30 weeks and who had been intubated for at least seven days. Infants were randomly assigned to receive either hydrocortisone or a placebo.

The results were not what researchers had anticipated. Watterberg and her colleagues discovered hydrocortisone did not reduce the incidence of BPD.

“So, I’m very disappointed, obviously, that it didn’t work, but it was still highly worth doing,” she said.

Watterberg added she was surprised NEJM published the findings given the negative outcome of the study.

“I was very impressed that they took it because it was a negative study,” she said. “Negative studies in medicine and science are harder to get published. They’re not as impactful as positive studies – people don’t pick up the enthusiasm from it – but they’re highly important to stop people from doing things that are not that helpful.”

According to the NEJM website, the publication receives more than 16,000 submissions each year. Approximately 5% of original research submissions achieve publication – with more than half of those coming from outside the U.S.

For Watterberg, it was a career high to have her paper accepted.

“I figure now that I have a first-author publication in The New England Journal, I don’t have to do anything else,” she joked.

While the results of Watterberg’s study, supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, weren’t what she had hoped, she did end up with some encouraging findings. Hydrocortisone didn’t make a difference in treating the BPD, but the drug did increase the success rate in removing premature infants from ventilators.

“Now the question is if you can get the babies extubated sooner, will people want to use it for that reason?” she said. “Babies obviously hate to be intubated – they hate having a thing down their throat. Parents hate it because it makes it a lot harder to take care of the baby and interact with the baby.”

So, she said, she’s curious if neonatal medical teams might now seek out hydrocortisone in hopes of speeding up the extubation process.

“That’s going to be a judgment call for everybody to make,” she said.