Prevalence of low cortisol values in term and near-term infants with vasopressor-resistant hypotension.
OBJECTIVE
To determine the prevalence of low cortisol values and to evaluate clinical responses to hydrocortisone in ill term and near-term newborns.


METHODS
Retrospective cohort study including infants >or=35 weeks gestational age who were mechanically ventilated, received vasopressor therapy, and had a cortisol concentration obtained for evaluation of vasopressor-resistant hypotension. In those infants treated with hydrocortisone, physiologic responses were evaluated and correlated with cortisol values (<15 vs >or=15 microg/dl).


RESULTS
A total of 32 infants had cortisol values obtained; 18 (56%) were <15 microg/dl. In all, 21 infants were treated with hydrocortisone of whom 13 had cortisol values <15 microg/dl. These 13 infants showed decreased heart rate, dopamine support and fluid bolus requirements after treatment, compared to infants with values >or=15 microg/dl (n=8).


CONCLUSIONS
A significant number of hypotensive, mechanically ventilated infants have evidence of inadequate adrenal function. Hydrocortisone therapy resulted in hemodynamic stabilization in this population.
Fernandez
Erika
E
Department of Pediatrics/Neonatology (E.F., K.W.), The University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA.
Schrader
Ron
R
Watterberg
Kristi
K
D000309:Adrenal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D015331:Cohort Studies; D004351:Drug Resistance; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000627:therapeutic use*; D007022:Hypotension / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents
D014662:Vasoconstrictor Agents; D006854:Hydrocortisone