Acute effect of hydrocortisone for respiratory deterioration in preterm infants: Oxygenation, ventilation, vital signs, and electrolytes

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.