Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension

Objective. To study the cardiovascular effects of hydrocortisone in preterm infants with hypotension unresponsive to volume and pressor administration. Study Design. Retrospective review of the cardiovascular response to 23 courses of hydrocortisone administration during the first day of treatment in 21 preterm infants (gestational age: 26.9 +/- 3.9 weeks; postnatal age: 11.3 +/- 13.1 days). Hydrocortisone (2 mg/kg/d in 16 patients and 3-6 mg/kg/d in 5 patients) was administered when dopamine (22.2 +/- 11 mug/kg/min, range: 8-60) alone (n = 16) or in combination with dobutamine (8.4 +/- 4.9 mug/kg/min, range: 5-20, n = 7) and/or epinephrine (0.38 +/- 0.56 mug/kg/min, range: 0.01-1.2, n = 4) failed to normalize blood pressure. Results. Mean blood pressure increased from 29.3 +/- 4.1 to 34.1 +/- 5.2, 38.0 +/- 8.0, and 41.8 +/- 6.6 mm Hg by 2, 4, and 6 hours of hydrocortisone administration, respectively, and remained stable thereafter. Urine output increased despite a decrease in fluid administration during the first day of hydrocortisone treatment. The dose of dopamine and the number of patients receiving dobutamine and/ or epinephrine also decreased during the same period. Eighteen of the 21 patients survived. Conclusions. Preterm infants with volume- and pressor-resistant hypotension respond to hydrocortisone with rapid normalization of the cardiovascular status and sustained decreases in volume and pressor requirement.