An evaluation of hydrocortisone dosing for neonatal refractory hypotension

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.