Forthcoming Issue Vol. 20 No. 2 A DESCRIPTION OF HYDROCORTISONE USE AND OUTCOMES IN INOTROPE RESISTANT HYPOTENSIVE PRETERM NEONATES AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL
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Abstract
Introduction: 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.
Aim: The aim of the study was to describe characteristics and outcomes of preterm neonates admitted to the neonatal intensive care unit (NICU) with hypotension and received hydrocortisone.
Method: This was 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%) administered hydrocortisone. Mean gestational age and birthweight were 32(+/-2.5) weeks and 1.47(+/-0.52) kgs respectively. More females presented with hypotension than males (54% versus 44%). Dobutamine (52%) was the most common inotrope used. The mean hydrocortisone dose was 4(2-12) hours. The commonest dosing frequency was 8 hourly in 107 (87.7%) neonates and hydrocortisone administration improved both systolic and diastolic blood pressures (p=0.001). Sepsis (p=0..3), nSOFA score >10 (p=0.001) and lenght of stay (p=0.001) were predictors of mortality. Sepsis (OR 3.66 95% CI:1.21-11.09) and a high nSOFA score (OR 1.37,95% CI: 1.01-1.84) were strongly associated with mortality.
Conclusion: Hydrocortisone significantly improved blood pressure in hypotensive preterm neonates. More studies should be undertaken to strengthen current protocols and improve outcomes.
Keywords: neonate, hypotension, hydrocortisone, preterm, survival.
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