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J Pediatr. 2019 May 30. pii: S0022-3476(19)30428-7. doi: 10.1016/j.jpeds.2019.04.008. [Epub ahead of print]

A Randomized Controlled Study of Low-Dose Hydrocortisone Versus Placebo in Dopamine-Treated Hypotensive Neonates Undergoing Hypothermia Treatment for Hypoxic-Ischemic Encephalopathy.

Author information

1
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
2
Planimeter Statistics Ltd, Budapest, Hungary.
3
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary; MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary.
4
University of Iowa Health Care, Iowa City, IA.
5
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary. Electronic address: jermendy.agnes@med.semmelweis-univ.hu.

Abstract

OBJECTIVE:

To investigate whether hydrocortisone supplementation increases blood pressure and decreases inotrope requirements compared with placebo in cooled, asphyxiated neonates with volume-resistant hypotension.

STUDY DESIGN:

A double-blind, randomized, placebo-controlled clinical trial was conducted in a Level III neonatal intensive care unit in 2016-2017. Thirty-five asphyxiated neonates with volume-resistant hypotension (defined as a mean arterial pressure [MAP] < gestational age in weeks) were randomly assigned to receive 0.5 mg/kg/6 hours of hydrocortisone or placebo in addition to standard dopamine treatment during hypothermia.

RESULTS:

More patients reached the target of at least 5-mm Hg increment of MAP in 2 hours after randomization in the hydrocortisone group, compared with the placebo group (94% vs 58%, P = .02, intention-to-treat analysis). The duration of cardiovascular support (P = .001) as well as cumulative (P < .001) and peak inotrope dosage (P < .001) were lower in the hydrocortisone group. In a per-protocol analysis, regression modeling predicted that a 4-mm Hg increase in MAP in response to hydrocortisone treatment was comparable with the effect of 15 μg/kg/min of dopamine in this patient population. Serum cortisol concentrations were low before randomization in both the hydrocortisone and placebo groups (median 3.5 and 3.3 μg/dL, P = .87; respectively), suggesting inappropriate adrenal function. Short-term clinical outcomes were similar in the 2 groups.

CONCLUSIONS:

Hydrocortisone administration was effective in raising the blood pressure and decreasing inotrope requirement in asphyxiated neonates with volume-resistant hypotension during hypothermia treatment.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT02700828.

KEYWORDS:

adrenal insufficiency; hydrocortisone supplementation; hypoxic−ischemic encephalopathy; low blood pressure

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