title: Time-course effect of a single dose of hydrocortisone for refractory hypotension in preterm infants.
abstract: BACKGROUND
  The aim of this study was to determine the time-course effect of a single dose of hydrocortisone (HC) on arterial blood pressure in extremely low gestational age newborns (ELGAN) with refractory hypotension during the first 3 days of life.
  
  
  METHODS
  We carried out a matched case-control study of a cohort of 116 infants born between 23 and 27 weeks' gestation at a tertiary center. Twelve infants (10%) were treated with HC for refractory hypotension (HC group). HC was administered at a dose of 2 mg/kg when mean arterial pressure (MAP) was below 30 mmHg (25 mmHg for infants <25 weeks of gestational age) despite the use of inotropes and volume expanders. Changes in the MAP after the HC administration were compared with those in the infants who were not treated with HC and matched for gestational age (Control group).
  
  
  RESULTS
  The mean MAP before administration of HC was significantly lower in the HC group than that in the control group (24.0 ± 3.2 vs 33.3 ± 4.8 mmHg; P < 0.01). The mean MAP in the HC group increased significantly at 2 h after HC treatment, and then reached levels comparable to those in the Control group at 5 h (31.3 ± 4.0 vs 33.9 ± 4.7 mmHg; P= 0.18), and remained at normal levels until 12 h after HC treatment.
  
  
  CONCLUSIONS
  A single dose of HC treatment induces a rapid and sustained improvement in blood pressure in ELGAN with refractory hypotension.
authors.affiliation: Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Japan. mizobuchi_kch@hp.pref.hyogo.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Mizobuchi
authors.forename: Seiji
authors.initials: S
authors.lastname: Yoshimoto
authors.forename: Hideto
authors.initials: H
authors.lastname: Nakao
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone