Abstract
BackgroundPreterm infants with severe bronchopulmonary dysplasia require rescue therapy with glucocorticoids, and hydrocortisone is increasingly replacing dexamethasone. The standard for rescue therapy is unclear. AimTo quantify the short-term effects of respiratory rescue hydrocortisone of 4 mg/kg/day for 3 days. Study designRetrospective single-center study. SubjectsVentilator-dependent infants born at <28 weeks of gestation with an increased oxygen demand to maintain the target oxygen saturation at 88% to 95% >1 week after birth. Outcome measuresVentilator settings, SpO2/FiO2 ratio, heart rate, and blood parameters within 24 h before and 228 h after starting hydrocortisone. ResultsTwenty-five infants (median gestational age, 25.1 weeks) received hydrocortisone at a median age of 16 days. The median pre-therapy SpO2/FiO2 was 297 (interquartile range, 265–320) and began to rise after 12 h of administration, reaching 307 (interquartile range, 278–335). The increase in SpO2/FiO2 peaked from the third day to 3 days after therapy (median range, 341–356). SpO2/FiO2 decreased thereafter and remained unchanged from 6 and 7 days after therapy (median range, 304–314). The pCO2 level (median range, 49–53 mmHg) did not change significantly. The heart rate significantly decreased from −4 to −6 beats/min from the first day to 1 day after therapy. Systolic blood pressure increased by a median of 4 to 8 mmHg after therapy. Blood electrolytes and glucose were similar after therapy. ConclusionRescue hydrocortisone administration improved oxygenation without particular adverse effects at the stage of respiratory deterioration in preterm infants.
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