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Pediatrics. 2001 May;107(5):1070-4.

Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension.

Author information

1
Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. seri@email.chop.edu

Abstract

OBJECTIVE:

To study the cardiovascular effects of hydrocortisone in preterm infants with hypotension unresponsive to volume and pressor administration.

STUDY DESIGN:

Retrospective review of the cardiovascular response to 23 courses of hydrocortisone administration during the first day of treatment in 21 preterm infants (gestational age: 26.9 +/- 3.9 weeks; postnatal age: 11.3 +/- 13.1 days). Hydrocortisone (2 mg/kg/d in 16 patients and 3-6 mg/kg/d in 5 patients) was administered when dopamine (22.2 +/- 11 microg/kg/min, range: 8-60) alone (n = 16) or in combination with dobutamine (8.4 +/- 4.9 microg/kg/min, range: 5-20, n = 7) and/or epinephrine (0.38 +/- 0.56 microg/kg/min, range: 0.01-1.2, n = 4) failed to normalize blood pressure.

RESULTS:

Mean blood pressure increased from 29.3 +/- 4.1 to 34.1 +/- 5.2, 38.0 +/- 8.0, and 41.8 +/- 6.6 mm Hg by 2, 4, and 6 hours of hydrocortisone administration, respectively, and remained stable thereafter. Urine output increased despite a decrease in fluid administration during the first day of hydrocortisone treatment. The dose of dopamine and the number of patients receiving dobutamine and/or epinephrine also decreased during the same period. Eighteen of the 21 patients survived.

CONCLUSIONS:

Preterm infants with volume- and pressor-resistant hypotension respond to hydrocortisone with rapid normalization of the cardiovascular status and sustained decreases in volume and pressor requirement.

Comment in

PMID:
11331688
[Indexed for MEDLINE]

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