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Original articles: P C Ng, C W K Lam, T F Fok, C H Lee, K C Ma, I H S Chan, and E Wong Refractory hypotension in preterm infants with adrenocortical insufficiency Arch. Dis. Child. Fetal Neonatal Ed. 2001; 84: F122-F124 [Abstract] [Full text] [PDF]

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Hydrocortisone:Early treatment of hypotension in preterm infants

A Soe   (3 May 2001)

Hydrocortisone:Early treatment of hypotension in preterm infants 3 May 2001
A Soe, Consultant Neonatal Paediatrician BAPM Send letter to journal: Re: Hydrocortisone:Early treatment of hypotension in preterm infants aungsoe{at}doctors.org.uk A Soe	Dear Editor We note with interest the paper by Ng et al[1]. Their study concluded that corticosteriod treatment could be lifesaving in severely hypotensive preterm infants who do not respond to conventional treatment with volume expanders and inotropes. The use of steroids in the management of hypotension in very low birthweight has already been shown to be effective [2]. We wrote to this Journal in 1993 [3] followed by an oral presentation at the Summer Meeting of the Neonatal Society regarding our experience in hydrocortisone (HC) as a prophylaxis used in babies less than 28 weeks gestation. We used the dose of 1.5mg/kg/dose four doses per day for the first 2-3 days and then tapered off over 7 days. We reviewed the six month experience and compared it with the preceding six months prior to the use of prophylaxis. We concluded that the prophylactic use of HC decreased the incidence of refractory hypotension and the need for dopamine and dobutamine. No significant difference was noted in the incidence of intraventricular haemorrhage and mortality. However, there was suggestion of an increase of incidence of sepsis and especially after the study period there were two deaths associated with systemic fungal infections. Therefore, from March 1998, we changed our policy from prophylatic use to treatment in infants less than 28 weeks gestation before intropes are used. We also reduced the dose to 1mg/kg/dose two doses per day for 3 days and weaned over 6 days by assuming a normal basal secretion of 6mg/m2/day and stress production rate of 24mg/m2/day and the surface area in 1kg baby is 0.1m2. From March 1998 to December 2000, 105 babies less than 28 weeks were admitted to the unit and 48 babies received HC for treatment of hypotension. 44 also required dopamine 5-15mcg/kg/min and 20 also required dobutamine 5-20mcg/kg/min. None of the babies required other inotropic support or a higher dose of HC. There was one case of systemic candidiasis and incidence of intraventricular haemorrhage and bacteria sepsis are comparable with the published data. Although most of the babies still required dopamine, we have not seen severe and refractory hypotension for more than three yeras and the lower dose of HC can be used. References (1) Ng PC et al. Refractory Hypotension in Preterm infants with Adrenal cortical insufficiency. Arch Dis Child 2001;84:F122-124 (2) Pourchierd, Western P. Randomised Trial of Dopamine compared with Hydrocortisone for the treatment of Hypotensive Very low birthweight infants. Arch Dis Child 1997; 76:F174-183 (3) Rajah V. Treatmant of Hypotension in Very low birthweight infants.(letter) Arch Dis Child 1998; 78:F158 A Soe, R Ebel, B Jani, T Ducker Oliver Fisher Neonatal Unit Medway Maritime Hospital Gillingham. Kent ME7 5NY