E S Peeples1. 1. Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: 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.
OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: 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.
Authors: Kristi L Watterberg; Jeffrey S Gerdes; Cynthia H Cole; Susan W Aucott; Elizabeth H Thilo; Mark C Mammel; Robert J Couser; Jeffery S Garland; Henry J Rozycki; Corinne L Leach; Conra Backstrom; Michele L Shaffer Journal: Pediatrics Date: 2004-12 Impact factor: 7.124
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Authors: Neil N Finer; Richard J Powers; Chia-hao Simon Ou; David Durand; David Wirtschafter; Jeffrey B Gould Journal: Pediatrics Date: 2006-03 Impact factor: 7.124