Hydrocortisone use and outcomes in inotrope- resistant hypotensive preterm neonates in a tertiary care unit in Johannesburg, South Africa
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Abstract
Background. Hypotension in preterm infants remains a major cause of morbidity and mortality. Hydrocortisone has been documented to improve blood pressure in inotrope-resistant preterm infants though there is limited information about its efficacy and outcomes.
Objective. To describe the characteristics and outcomes of preterm neonates who were admitted to the neonatal intensive care unit (NICU) with hypotension and received hydrocortisone.
Method. We conducted a retrospective descriptive study of hypotensive preterm neonates admitted at the NICU in Chris Hani Baragwanath Academic Hospital (CHBAH) between January and December 2020.
Results. Of 191 hypotensive preterm neonates, 176 (92.1%) received inotropes, with 122 (69.3%) of these being administered hydrocortisone. The mean (standard deviation) gestational age was 32 (2.5) weeks and the median (interquartile range (IQR)) birthweight in hydrocortisone recipients was 1.350 kg (1.120 - 1.801). Dobutamine was the most commonly used inotrope (52%) in the cohort. The mean (SD) hydrocortisone dose was 3.2 (1.0) mg/kg/day and administered 8 hourly in 107 (87.7%) of neonates with the median (IQR) time of 4 (2 - 12) hours from the first inotrope. Hydrocortisone administration improved both systolic and diastolic blood pressures (p=0.001). The predictors of neonatal mortality were sepsis (p=0.003) (OR 3.66; 95% CI 1.21 - 11.09) and neonatal Sequential Organ Failure Assessment (nSOFA) score >10 (p=0.001) (OR 1.37, 95% CI 1.01 - 1.84).
Conclusion. Hydrocortisone significantly improved blood pressure in hypotensive preterm neonates. More studies should be undertaken to strengthen current protocols and improve outcomes.
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References
1. Dempsey EM, Barrington KJ, Marlow N, et al. Hypotension in Preterm Infants (HIP) randomised trial. Arch Dis Child - Fetal Neonatal Ed 2021;106(4):398- 403. https://doi.org/10.1136/archdischild-2020-320241
2. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med 2017;45(6):1061-1093. https://doi. org/10.1097/CCM.0000000000002425
3. Elsheikh RM, Elmashad AM, Aboelenin AM, Elrifaey SM. Relative adrenal insufficiency in full-term and preterm neonates with neonatal sepsis. Asian J Pediatr Res 2024;14(1):1-13. https://doi.org/10.9734/ajpr/2024/v14i1314
4. Huysman MWA, Hokken-Koelega ACS, De Ridder MAJ, Sauer PJJ. Adrenal function in sick very preterm infants. Pediatr Res 2000;48(5):629-633. https:// doi.org/10.1203/00006450-200011000-00013
5. Ping P, Yu B, Xu R, Zhao P, He S. Monitoring and evaluation of hypotension in the extremely preterm. Front Cardiovasc Med 2024;11:1477337. https://doi. org/10.3389/fcvm.2024.1477337
6. Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score: Development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019;23(1):374. https://doi.org/10.1186/s13054-019-2663-7
7. Wynn JL, Polin RA. A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants. Pediatr Res 2020;88(1):85-90. https://doi.org/10.1038/s41390-019-0517-2
8. Dempsey E, EL-Khuffash A. Clinical Trials in hemodynamic support. Clin Perinatol 2020;47(3):641-652. https://doi.org/10.1016/j.clp.2020.05.013
9. Kharrat A, Diambomba Y, Jain A. Corticosteroid use in neonatal hypotension: A survey of Canadian neonatologists. Pediatr Neonatol 2024;65(5):451-456. https://doi.org/10.1016/j.pedneo.2023.09.013
10. Watterberg KL. Adrenal insufficiency and cardiac dysfunction in the preterm infant. Pediatr Res 2002;51(4):422-424. https://doi.org/10.1203/00006450- 200204000-00004
11. The Chris Hani Baragwanath Hospital. https://www. chrishanibaragwanathhospital.co.za/ (accessed 29 April 2026).
12. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181-1247. https://doi.org/10.1007/s00134-021-06506-y
13. Das R, Nagpal R, Deshpande S, et al. A survey on management practices of hypotension in preterm neonates: an Indian perspective. Front Pediatr 2024;12:1411719. https://doi.org/10.3389/fped.2024.1411719
14. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 2001;21(5):272-278. https://doi.org/10.1038/sj.jp.7210563
15. Noori S, Friedlich P, Wong P, Ebrahimi M, Siassi B, Seri I. Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor- treated preterm and term neonates. Pediatrics 2006;118(4):1456-1466. https:// doi.org/10.1542/peds.2006-0661
16.Watterberg KL. Hydrocortisone dosing for hypotension in newborn infants: Less is more. J Pediatr 2016;174:23-26.e1. https://doi.org/10.1016/j. jpeds.2016.04.005
17. Ibrahim H, Sinha IP, Subhedar NV. Corticosteroids for treating hypotension in preterm infants. Cochrane Database Syst Rev 2011(12):CD003662. https:// doi.org/10.1002/14651858.CD003662.pub4
18. Bourchier D, Weston PJ. Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants. Arch Dis Child - Fetal Neonatal Ed 1997;76(3):F174-F178. https://doi. org/10.1136/fn.76.3.F174
19. Peeples ES. An evaluation of hydrocortisone dosing for neonatal refractory hypotension. J Perinatol 2017;37(8):943-946. https://doi.org/10.1038/ jp.2017.68
20. Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001;107(5):1070-1074. https://doi.org/10.1542/peds.107.5.1070
21. Ramaswamy VV, Kumar G, Pullattayil S AK, et al. Timing of hydrocortisone therapy in neonates with shock: A systematic review, meta-analysis, and clinical practice guideline. Front Pediatr 2025;13:1491976. https://doi. org/10.3389/fped.2025.1491976
22. Iqbal F, Chandra P, Khan AA, et al. Prediction of mortality among neonates with sepsis in the neonatal intensive care unit: A machine learning approach. Clin Epidemiol Glob Health 2023;24:101414. https://doi.org/10.1016/j. cegh.2023.101414
23. Gutierrez CE, De Beritto T. Relative adrenal insufficiency in the preterm infant. NeoReviews 2022;23(5):e328-e334. https://doi.org/10.1542/neo.23- 5-e328
24. Baker CFW, Barks JDE, Engmann C, et al. Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns. J Perinatol 2008;28(6):412-419. https://doi.org/10.1038/jp.2008.16