Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. 1456-1466 (doi:10.1542/peds.2006-0661)

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ARTICLE

Hemodynamic Changes After Low-Dosage Hydrocortisone Administration in Vasopressor-Treated Preterm and Term Neonates

Shahab Noori, MD^a, Philippe Friedlich, MD^a, Pierre Wong, MD^b, Mahmood Ebrahimi, MD^a, Bijan Siassi, MD^a,b and Istvan Seri, MD, PhD^a

^a Divisions of Neonatal Medicine
^b Cardiology, Department of Pediatrics, Childrens Hospital Los Angeles and Women's and Children's Hospital, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California

OBJECTIVE. We sought to investigate whether the increase in blood pressure and decrease in vasopressor support after hydrocortisone administration are associated with changes in systemic hemodynamics in neonates who receive high-dosage dopamine to maintain blood pressure at the lowest acceptable levels.

METHODS. In this prospective, observational study, preterm and term neonates who required dopamine 15 µg/kg per minute to maintain minimum acceptable blood pressure received intravenous hydrocortisone 2 mg/kg followed by up to 4 doses of 1 mg/kg every 12 hours. Fifteen preterm and 5 term neonates without a patent ductus arteriosus composed the study population. Echocardiograms and vascular Doppler studies were performed immediately before the first dose of hydrocortisone and at 1, 2, 6 to 12, 24, and 48 hours thereafter.

RESULTS. In the 15 preterm infants, during the first 12 hours of hydrocortisone treatment, the 28% increase in blood pressure paralleled that in the systemic vascular resistance without changes in stroke volume or cardiac output, whereas dopamine dosage decreased. By 24 hours, the dosage of dopamine continued to decrease, whereas stroke volume increased without additional changes in systemic vascular resistance. By 48 hours, dopamine dosage decreased by 72%; blood pressure and stroke volume increased by 31% and 33%, respectively; and systemic vascular resistance and cardiac output tended to be higher (14% and 21%, respectively) compared with baseline. Contractility, global myocardial function, and Doppler indices of blood flow in the middle cerebral and renal artery remained normal and unchanged. The findings in the 5 term infants showed a similar pattern for changes in cardiac function, systemic hemodynamics, and organ blood flow after hydrocortisone administration.

CONCLUSIONS. In preterm and term neonates who require high-dosage dopamine to maintain blood pressure at the lowest acceptable levels, hydrocortisone improves blood pressure without compromising cardiac function, systemic perfusion, or cerebral and renal blood flow.

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Key Words: preterm • blood pressure • cardiac function • brain blood flow • dopamine

Abbreviations: CBF—cerebral blood flow • BP—blood pressure • SVR—systemic vascular resistance • PDA—patent ductus arteriosus • MPI—myocardial performance index • SF—shortening fraction • WS—wall stress • VCF_C—heart rate–corrected velocity of circumferential fiber shortening • VTI—velocity time integral • MCA—middle cerebral artery • MV—mean velocity • PI—pulsatility index • ANOVA—analysis of variance

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Accepted Jun 1, 2006.

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