A Double-Blind, Randomized, Controlled Study of a "Stress Dose" of Hydrocortisone for Rescue Treatment of Refractory Hypotension in Preterm Infants

A Double-Blind, Randomized, Controlled Study of a "Stress Dose" of Hydrocortisone for Rescue Treatment of Refractory Hypotension in Preterm Infants

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 > or...

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Bibliographic Details
Published in:Pediatrics (Evanston) Vol. 117; no. 2; pp. 367 - 375
Main Authors: Ng, Pak C, Lee, Cheuk H, Bnur, Flora Liu, Chan, Iris H.S, Lee, Anthony W.Y, Wong, Eric, Chan, Hin B, Lam, Christopher W.K, Lee, Benjamin S.C, Fok, Tai F
Format: Journal Article
Language:English
Published: Elk Grove Village, IL Am Acad Pediatrics 01-02-2006
American Academy of Pediatrics
Subjects:
Babies
Biological and medical sciences
Birth weight
Blood Pressure - drug effects
Cortisone
Dopamine - administration & dosage
Double-Blind Method
Drug Administration Schedule
General aspects
Health aspects
Humans
Hydrocortisone - administration & dosage
Hypotension
Hypotension - drug therapy
Hypotension - physiopathology
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - drug therapy
Infant, Premature, Diseases - physiopathology
Infant, Very Low Birth Weight
Infants (Premature)
Medical sciences
Medical treatment
Pediatrics
Premature birth
Premature infants
Risk factors
Vasoconstrictor Agents - administration & dosage
United States
hypotension
Corticosteroid
Pediatrics
Rescue
Treatment resistance
Steroid hormone
preterm infants
Antiinflammatory agent
adrenocortical insufficiency
Cardiovascular disease
Hydrocortisone
Glucocorticoid
Posology
Stress
Refractory
Newborn diseases
Randomization
Treatment
Prematurity
Arterial hypotension
Adrenal hormone
Double blind study
Dose
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Summary: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 > or =10 microg/kg per min could wean off vasopressor support 72 hours after treatment with hydrocortisone. A double-blind, randomized, controlled study was conducted in a university neonatal center. Forty-eight VLBW infants who had refractory hypotension and required dopamine > or =10 microg/kg per min were randomly 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). The baseline clinical characteristics were similar between the groups. Serum cortisol concentrations were very low immediately before randomization 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 expander, 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. 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 refractory hypotension in emergency and life-threatening situations.
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ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2005-0869