An evaluation of hydrocortisone dosing for neonatal refractory hypotension

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The objective of the study was to compare blood pressure, vasoactive medication requirements and adverse outcomes after administration of high- versus low-dose hydrocortisone (HC) in preterm infants.


This is a retrospective analysis of 106 infants ≤ 28 weeks gestational age with hypotension requiring vasoactive infusions and high-dose (4 mg kg-1 per day, n = 50), low-dose (1 to 3 mg kg-1 per day, n = 20) or no HC (n = 36) from 2011 to 2015. Groups were compared by two-tailed t-test or χ2, and correlation estimated by multivariable logistic regression.


There were no differences in measured efficacy between the low- and high-dose groups. Infants with pre-treatment cortisol > 15 mcg dl-1 who received HC therapy showed less improvement in vasoactive burden, increased hyperglycemia (P = 0.015) and increased death independent of HC dose (odds ratio 26.3, 3.5 to 198.3, P = 0.002).


These results support using the lowest effective HC dose in preterm infants. In addition, HC therapy should likely be avoided in infants who are not cortisol deficient.

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