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.