title: Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor-treated preterm and term neonates.
abstract: 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 > or = 15 microg/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.
authors.affiliation: USC Division of Neonatal Medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS #31, Los Angeles, CA 90027, USA. snoori@chla.usc.edu
authors.forename: Shahab
authors.initials: S
authors.lastname: Noori
authors.forename: Philippe
authors.initials: P
authors.lastname: Friedlich
authors.forename: Pierre
authors.initials: P
authors.lastname: Wong
authors.forename: Mahmood
authors.initials: M
authors.lastname: Ebrahimi
authors.forename: Bijan
authors.initials: B
authors.lastname: Siassi
authors.forename: Istvan
authors.initials: I
authors.lastname: Seri
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects*; D001921:Brain / Q000098:blood supply; D002302:Cardiac Output / Q000187:drug effects; D004298:Dopamine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology*; D007231:Infant, Newborn; D007234:Infant, Premature; D007668:Kidney / Q000098:blood supply; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D004298:Dopamine; D006854:Hydrocortisone