title: [Hydrocortisone for the treatment of refractory hypotension: a randomized controlled trial].
abstract: BACKGROUND
  Systemic hypotension is a common sign in critically sick infants. Several studies have suggested that the use of short series of corticosteroids increases arterial blood pressure and reduces the inotropic support needs in preterm neonates with hypotension. There are a small number of reports on the use of hydrocortisone (HC) for the treatment of refractory hypotension in infants.
  
  
  METHODS
  To assess the effectiveness of hydrocortisone in the reduction of inotropic support in infants with refractory hypotension.
  
  
  METHODS
  infants who required dopamine ≥ 14 μg/kg/min and/or epinephrine.
  
  
  METHODS
  prospective, controlled, randomized, double blind trial with placebo.
  
  
  METHODS
  2.5mg/kg every 12 hours, for 48 hours intravenously (intervention group [IG]); placebo: isotonic saline 1.25 ml/kg/doses intravenously (placebo group [PG]) every 12 hours, for 48 hours. Randomization was performed in blocks with blind assignment.
  
  
  RESULTS
  A total of 50 infants with refractory systemic hypotension were prospectively recruited. Patient characteristics were similar in both groups. Requirements for inotropic support at 48 hrs were achieved in 60%, of the IG versus 24% of the PG (P=.009, RR: 2.5, 95% CI, 1.16-5.38). A significant association was observed between the administration of HC in infants treated with epinephrine and the presence of hyperglycemia (P =.008).
  
  
  CONCLUSIONS
  In patients with refractory hypotension hydrocortisone administration reduced the need for inotropic support. Further studies with a greater number of patients are needed to confirm the effectiveness of HC as a therapeutic tool in these infants.
authors.affiliation: Área de Terapia Intensiva Neonatal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Salas
authors.affiliation: Área de Farmacia, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: M
authors.initials: M
authors.lastname: Travaglianti
authors.affiliation: Área de Farmacia, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Leone
authors.affiliation: Área de Terapia Intensiva Neonatal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: C
authors.initials: C
authors.lastname: Couceiro
authors.affiliation: Docencia e Investigación, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Área de Terapia Intensiva Neonatal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: dianaf@fibertel.com.ar.
authors.forename: D
authors.initials: D
authors.lastname: Fariña
mesh_terms: D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007022:Hypotension / Q000188:drug therapy*; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies
chemical_list: D006854:Hydrocortisone
keywords: Dopamina; Dopamine; Epinefrina; Epinephrine; Esteroides; Hidrocortisona; Hipotensión; Hydrocortisone; Hypotension; Inotropes; Inotrópicos; Steroids