Hydrocortisone for hypotension and vasopressor dependence in preterm neonates: a meta-analysis.
BACKGROUND
A full consensus has not been reached about the hemodynamic efficacy of hydrocortisone administration in hypotensive and vasopressor-dependent preterm neonates.


OBJECTIVE
To examine the efficacy of hydrocortisone for treatment of hypotension and reduction of vasopressor requirements in preterm infants.


METHODS
Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels.


RESULTS
Random effects meta-analysis showed that hydrocortisone increases blood pressure (seven studies; N=144; r=0.71, 95%CI=0.18 to 0.92) and reduces vasopressor requirement (five studies; N=93; r=0.74, 95%CI=0.0084 to 0.96). The number of new or unretrieved studies averaging null results required to increase the overall p to 0.05 is k=78 for blood pressure increase and k=47 for vasopressor requirement reduction.


CONCLUSIONS
The effects of hydrocortisone on increasing blood pressure and decreasing vasopressor requirements in preterm infants are robust with a large tolerance for future null results. Actual clinical benefits of increasing blood pressure and decreasing vasopressor requirements, however, remain unknown. Long-term sequelae of hydrocortisone administration have yet to be fully elucidated.
Higgins
S
S
Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
Friedlich
P
P
Seri
I
I
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D006854:Hydrocortisone