Low-dose hydrocortisone in pediatric septic shock: an exploratory study in a third world setting.
OBJECTIVE
To study the efficacy of low-dose intravenous hydrocortisone therapy in the management of pediatric septic shock with respect to the time taken for shock reversal and requirement of inotropes.


METHODS
Open label randomized pilot study.


METHODS
Pediatric intensive care unit of a tertiary care pediatric center in a third world country.


METHODS
Thirty-eight children, 2 months-12 yrs of age, with septic shock unresponsive to fluid therapy alone.


METHODS
Intravenous hydrocortisone 5 mg/kg/day in four divided doses followed by half the dose for a total duration of 7 days or normal saline (similar amount in a similar manner) for the same duration.


RESULTS
There was a trend toward earlier reversal of shock (median 49.5 vs. 70 hrs, p = 0.65, Mann-Whitney U test) and lower inotropes requirement (median {lsqb;10th-90th centile{rsqb; inotropes score: 20 {lsqb;15-60{rsqb; vs. 50 {lsqb;20-80{rsqb;, p = 0.15) in the hydrocortisone-treated patients as compared with controls, although the difference was not statistically significant. Mortality rate was similar in both groups.


CONCLUSIONS
Our data, although, inconclusive favor the need for a study with a larger sample size to clearly define role of low-dose hydrocortisone in pediatric septic shock in developing countries, while taking in consideration effect of malnutrition, delayed presentations, and their interactions with the hypothalamic-pituitary-adrenocortical axis.
Valoor
Harsha T
HT
Department of Pediatrics Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Singhi
Sunit
S
Jayashree
M
M
D002423:Cause of Death; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006784:Hospitals, Teaching; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007194:India; D007223:Infant; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D053208:Kaplan-Meier Estimate; D008297:Male; D010865:Pilot Projects; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
D006854:Hydrocortisone