Inhaled steroids do have some side effects, although usually not the side effects that people normally think of with “steroids”. Inhaled steroids can cause thrush (yeast infection in the throat) and hoarseness. Both of these can be minimized by rinsing the mouth after using. Inhaled steroids do have a small effect on bone density and in someone already prone to osteoporosis might be an additional risk factor. Things like weight gain, mood changes, blood sugar elevation and immune system suppression really aren’t an issue with inhaled steroids because the total dose to the body is extremely low. For most patients, the benefits of being on an inhaled steroid FAR FAR FAR outweigh the risk.
There have been no randomized trials examining the effect of hydrocortisone given after the first week of life or used to treat infants with prolonged ventilator dependence. One retrospective cohort study compared infants who required assisted ventilation and oxygen after the first one to two weeks of age and received hydrocortisone with a group of healthier infants who did not receive hydrocortisone.  Infants treated with hydrocortisone experienced decreasing oxygen requirements and were successfully weaned from assisted ventilation. After seven days of treatment, there were no differences in oxygen requirements between the two groups. On follow-up, there were no differences in head circumference, neurological outcome, psychomotor development or school performance. Magnetic resonance imaging performed at eight years of age on a similar cohort of infants treated with hydrocortisone showed that although, overall, children born preterm had significantly reduced grey matter volumes compared to term children, there were no differences in the intracranial volumes, grey matter volumes or white matter volumes between children who did and did not receive hydrocortisone for treatment of CLD.  There were also no differences in neurocognitive outcomes, assessed using the Wechsler Intelligence Scales for Children.