A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

Efird, M.; Heerens, Ann T.; Gordon, Phillip V.; Bose, Carl; Young, David A.

doi:10.1038/sj.jp.7211193

Cited by 99 publications

(62 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…40,45 Studies of prophylactic glucocorticoids for the prevention of hypotension have also shown improved blood pressures and reduced need for vasopressors. 33,43,46,47 In the largest study, 360 intubated ELBW infants were randomized to receive either prophylactic treatment with hydrocortisone (1 mg per kg per day) or placebo for 12 days to prevent bronchopulmonary dysplasia. Daily mean arterial pressures were significantly higher in the hydrocortisone-treated infants.…”

Section: Clinical Evidencementioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

View full text Add to dashboard Cite

Cortisol release in the face of illness or stress is vital for survival. Relative adrenal insufficiency occurs when a patient's cortisol response is inadequate for the degree of illness or stress. Numerous studies have documented the existence of relative adrenal insufficiency in critically ill adults, and its association with increased morbidity and mortality. There is increasing evidence that relative adrenal insufficiency may be an etiology for hemodynamic instability and hypotension in the critically ill newborn, but compared with the adult population, there is still a paucity of data in this population. Randomized controlled trials are needed to evaluate the efficacy and safety of glucocorticoids for the treatment of cardiovascular insufficiency due to relative adrenal insufficiency in ill preterm and term newborn infants. Keywords: adrenocorticotropin; ACTH; adrenal insufficiency; corticotrophin-releasing hormone; cortisol; critically ill infants hypothalamic-pituitary-adrenal axis; newborns-full term Introduction Activation of the hypothalamic-pituitary-adrenal (HPA) axis and ultimate release of cortisol are critical in maintaining homeostasis in response to stress. Relative adrenal insufficiency occurs when the HPA axis produces insufficient cortisol for the degree of illness or stress. In some critically ill adult populations, relative adrenal insufficiency is prevalent, 1-4 and is associated with increased morbidity and mortality. 2,3,5 Some studies of glucocorticoid treatment in critically ill adults have shown benefit, with faster reversal of shock and reduction in mortality. 3,[5][6][7][8] Recently, increasing evidence supports the existence of relative adrenal insufficiency in ill newborns, but, similar to other ill populations, there remains no general consensus on which patients should be tested, which tests to use and how to interpret them, which patients should be treated or how they should be treated. 9 The following discussion is an overview of corticosteroid physiology, relative adrenal insufficiency in critically ill populations and evidence of its existence in newborn infants, with proposed underlying

show abstract

Section: Clinical Evidencementioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

View full text Add to dashboard Cite

show abstract

“…There are a number of prospective randomized trials addressing the efficacy of corticosteroid use for both the prevention and treatment of hypotension. [26][27][28][29][30] In one of the prophylactic studies a reduction in inotrope use was noted, 29 but no difference in inotrope use in the second. 30 There was a clinically significant increase in the number of adverse effects including hyperglycemia necessitating insulin infusion and gastric perforation in the treated group.…”

Section: (1-8)mentioning

confidence: 99%

Serum cortisol values, superior vena cava flow and illness severity scores in very low birth weight infants

et al. 2010

View full text Add to dashboard Cite

Objective: Recent evidence suggests that high cortisol concentrations are associated with increased morbidity and mortality in very low birth weight (VLBW) infants. Neonatal illness severity and mortality risk scores are reliable in predicting morbidity and mortality. The objectives were (i) to assess the correlation between serum cortisol levels and clinical assessment of multi-organ dysfunction/illness severity scores (CRIB II, SNAPPE-II and neonatal multiple organ dysfunction score (NEOMOD)) in first 24 h in VLBW infants and (ii) to assess the relationship between surrogates of end organ blood flow and serum cortisol levels.Study Design: A prospective observational cohort study. Neonates with birth weight <1500 g were eligible for enrollment. Echocardiography evaluation of superior vena cava (SVC) flow was carried out in the first 24 h life. Cortisol levels were measured simultaneously and appropriate clinical scores were calculated.Result: A total of 54 VLBW neonates were enrolled following parental consent. Two patients were excluded because of congenital malformations. In 14 babies the cortisol value was not simultaneously obtained. The mean birth weight was 1.08 kg, mean gestational age was 27.8 weeks. There was a significant correlation between cortisol and NEOMOD score (P ¼ 0.006). There was no correlation between cortisol and CRIB II score (P ¼ 0.34), SVC flow (P ¼ 0.49) and mean arterial blood pressure respectively (P ¼ 0.35). Conclusion:There was no correlation between SVC flow and cortisol values or between cortisol and mean blood pressure values. There was a significant correlation between cortisol levels and neonatal organ dysfunction score evaluated suggesting that stressed VLBW infants do mount a cortisol response. Keywords: VLBW; neonate; cortisol; superior vena cava; blood pressure; illness severity score IntroductionThe immediate postnatal period in very low birth weight (VLBW) infants is frequently complicated by hypotension and low end-organ flow. Superior vena cava (SVC) flow has proven to be a useful marker of systemic blood flow, 1 but is not easily obtained at the bedside. Blood pressure values are readily available at the bedside and hypotension has been associated with adverse short-term and long-term outcome.2,3 A number recent studies have focused on evaluating the role of hydrocortisone therapy in hypotension and suspected adrenocortical insufficiency in the sick preterm infants during the early course of life.

show abstract

“…Many of these infants have been shown to respond to the use of corticosteroids, with normalization of arterial blood pressure and a reduction of the dose of vasopressor drugs (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Cortisol and 17-a-hydroxy-progesterone levels in infants with refractory hypotension born at 30 weeks of gestation or less

Martins¹,

Procianoy²

2007

Braz J Med Biol Res

View full text Add to dashboard Cite

Refractory hypotension is frequent in very low-birth weight infants, whose hypothalamic-pituitary-adrenal axis has been suggested to be immature. The objective of the present study was to evaluate basal cortisol and 17-α-OH-progesterone in the first 36 h of life in preterm infants with and without refractory hypotension (mean arterial blood pressure below the lower limit for gestational age throughout the study despite aggressive volume expansion and use of vasopressors). Thirtyfive infants with ≤30 weeks of gestation and a birth weight ≤1250 g, with no postnatal use of corticosteroid or death in the first 48 h were studied. Mean arterial pressure was measured every 4 h during the first 48 h. Cortisol and 17-α-OH-progesterone were determined at 12 and 36 h and patients were divided into refractory hypotensive (N = 15) and control (N = 20) groups. The groups were not different regarding type of delivery, use of prenatal corticosteroid, requirement of mechanical ventilation, use of vasopressor drugs, morphine, fentanyl, prophylactic indomethacin, and mean sample timing. Although refractory hypotensive newborns were more immature, were smaller, suffered more deaths after 48 h of life and had a higher SNAPPE-2 score, their cortisol and 17-α-OH-progesterone levels were not different from controls at 12 h and at 36 h. The increase of cortisol in newborns with refractory hypotension 36 h after birth was significantly higher than in controls. Despite the fact that refractory hypotensive very low-birth weight neonates were submitted to a very stressful condition, their cortisol and 17-α-OH-progesterone levels were similar to controls.

show abstract

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

Cited by 99 publications

References 40 publications

Relative adrenal insufficiency in the preterm and term infant

Relative adrenal insufficiency in the preterm and term infant

Serum cortisol values, superior vena cava flow and illness severity scores in very low birth weight infants

Cortisol and 17-a-hydroxy-progesterone levels in infants with refractory hypotension born at 30 weeks of gestation or less

Contact Info

Product

Resources

About