Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2540-2542 (doi:10.1542/peds.2006-2250)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Hallman, M. Articles by Saarela, T. Search for Related Content PubMed PubMed Citation Articles by Hallman, M. Articles by Saarela, T. Related Collections Premature & Newborn Social Bookmarking                         What's this?

COMMENTARY

Early Neonatal Hydrocortisone: Study Rather Than Treat

Mikko Hallman, MD, PhD, Outi Peltoniemi, MD and Timo Saarela, MD, PhD

Department of Pediatrics, University of Oulu, Oulu, Finland

Abbreviations: BPD, bronchopulmonary dysplasia • PDA, patent ductus arteriosus • BW, birth weight

The first 20% of the full text of this article appears below.

Hydrocortisone at doses corresponding or exceeding the endogenous corticosteroid secretion during stress has been studied in randomized trials since the early 1970s.¹ Lately, the aim has been to stabilize very low blood pressure or decrease the risk of bronchopulmonary dysplasia (BPD).^2,3

According to experimental studies, the beneficial hemodynamic effects are largely a result of an increase in myocardial smooth muscle contractility.⁴ Corticosteroids increase cardiovascular adrenergic receptors and enhance the microvascular endothelial barrier function, and hydrocortisone has a mineralocorticoid-mediated effect on cardiac muscle. Closure of patent ductus arteriosus (PDA) is promoted by corticosteroid, which also decreases the synthesis of prostaglandins and endothelial nitric-oxide synthetase.⁵ The blood pressure is just one function that, together with perfusion resistance and oxygen carrying capacity of the blood, determine the oxygen delivery to the tissue. The pressure-passive cerebral perfusion evident in some very preterm infants argues for interventions that increase and stabilize the perfusion pressures.

Beneficial hemodynamic effects of hydrocortisone have been observed in randomized, placebo-controlled trials. In a single-center randomized trial of 48 preterm infants (mean gestational age: 26.6 weeks; birth weight [BW]: <1500 g [mean: 920 g]), hydrocortisone was given at 3 mg/kg per day, divided into 3 intravenous injections for 4 days, starting during the first week (a mean of 11 hours after birth) for treatment of refractory hypotension.³ Despite an increase in mean blood pressure, there was a decrease in the requirement for dopamine, dobutamine, and saline infusions and no detectable effects on PDA or other outcomes. In 3 randomized trials in which the influence of early neonatal hydrocortisone on survival without BPD was studied, the acute hemodynamic changes were . . . [Full Text of this Article]

Address correspondence to Mikko Hallman, MD, PhD, Department of Pediatrics, University of Oulu, PO Box 5000, University of Oulu, FIN-90014 Oulu, Finland. E-mail: mikko.hallman@oulu.fi

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K J Rademaker, L S de Vries, C S P M Uiterwaal, F Groenendaal, D E Grobbee, and F van Bel Postnatal hydrocortisone treatment for chronic lung disease in the preterm newborn and long-term neurodevelopmental follow-up Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2008; 93(1): F58 - F63. [Abstract] [Full Text] [PDF]