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

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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

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