Treatment of hypotension in very low birthweight infants
Editor—We note with interest the paper by Bourchier and Weston.1 Their study concluded that both hydrocortisone and dopamine were effective treatments for hypotension in very low birthweight (VLBW) infants. The use of steroids in the management of hypotension in very low birthweight infants has already been shown to be effective anecdotally or in small uncontrolled studies.2 3
In our experience with a similar group of VLBW infants and even in those with a mean gestation less than in the study group, we have used hydrocortisone as a prophylactic measure. Infants less than 27 weeks of gestation were routinely administered bolus doses of hydrocortisone for the first 2 to 3 days which was then tapered off. If inotropes were needed in addition, then the hydrocortisone was given for an extended period of time, well after discontinuation of inotropes.
Our results so far, albeit in a small sample size (n = 20) and with a mean gestation of 25 weeks, have shown that the number of infants who required inotropic support to treat hypotension in this group has been small. Furthermore, since the introduction of prophylactic hydrocortisone, we have not had any cases of refractory hypotension. We have also failed to show any increase in the incidence of infections (bacterial or candidal)4 or intraventricular haemorrhage.
We note that the maintenance dose of hydrocortisone used in Bourchier and Weston’s study was 2.5 mg/kg every 6 hours. We have used smaller doses of 1.5 mg/kg every 6 hours and given over 20–30 minutes. This regimen has given us similar treatment outcomes outlined in their study.
In those infants who have required more prolonged courses of hydrocortisone we have encountered problems with hyperglycaemia and occasionally ventricular and septal hypertrophy.
We believe that a prospective randomised controlled trial comparing prophylactic hydrocortisone to placebo treatment is required.
