Journal of perinatology : official journal of the California Perinatal Association · 2017
An evaluation of hydrocortisone dosing for neonatal refractory hypotension.
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Аннотация
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.
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.
Предметные рубрики MeSH
Blood PressureDose-Response Relationship, DrugDrug ResistanceFemaleGlucocorticoidsHumansHydrocortisoneHyperglycemiaHypotensionInfantInfant MortalityInfant, NewbornInfant, PrematureInfant, Premature, DiseasesMaleOutcome and Process Assessment, Health CareRetrospective StudiesUnited StatesVasoconstrictor Agents