Cardiovascular Effects of Hydrocortisone in Preterm Infants With Pressor-Resistant Hypotension

Abstract

Preterm infants with volume- and pressor-resistant hypotension respond to hydrocortisone with rapid normalization of the cardiovascular status and sustained decreases in volume and pressor requirement.

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

“…1,20,30,31 These patients with vasopressor dependence or vasopressor-resistant hypotension respond to relatively low doses of hydrocortisone with an improvement in blood pressure and urine output, and frequently wean off vasopressor support within 24-72 h. 1,20,[30][31][32][33] Factors that may explain the corticosteroid responsiveness of vasopressorresistant hypotension in these neonates include the downregulation of cardiovascular adrenergic receptors in critical illness 33 and the development of relative adrenal insufficiency. 30,31,34 The attenuated cardiovascular responsiveness to catecholamines in critical illness is, at least in part, caused by the downregulation of the cardiovascular adrenergic and type-1 angiotensin-2 receptors and their intracellular signaling systems.…”

“…30,31,34 The attenuated cardiovascular responsiveness to catecholamines in critical illness is, at least in part, caused by the downregulation of the cardiovascular adrenergic and type-1 angiotensin-2 receptors and their intracellular signaling systems. 31,33,35 As expression of these receptors and their signaling systems is inducible by corticosteroids, 36 steroid administration has the potential to reverse adrenergic receptor downregulation. In addition, corticosteroids inhibit prostacyclin production and the induction of nitric oxide synthase, 37 and thus limit the pathological vasodilation associated with the nonspecific or specific inflammatory response of the critically ill neonate.…”

“…In addition to these genomic effects, corticosteroids exert certain nongenomic actions, 38 resulting in a rapid increase in the sensitivity of the cardiovascular system to catecholamines. 33,38 Relative adrenal insufficiency, especially in the VLBW neonate, is the other factor contributing both to the increased incidence of vasopressor resistance and the enhanced responsiveness to hydrocortisone in this patient population. 34 In the VLBW neonate, relative adrenal insufficiency is thought to contribute to the disruption of the balance between adrenergic receptor destruction and synthesis, resulting in decreased sensitivity of the cardiovascular system to endogenous and exogenous catecholamines.…”

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

“…Our observation complements earlier reports that this therapy is an effective treatment of hypotension that is refractory to VP. 6,[16][17][18] The primary end point of this study, treatment with VP is based on an operational definition of hypotension and a care practice in response to this a priori definition. Both the definition and treatment of hypotension are controversial in ELBW infants, but we felt that this was the best available methodology at the time of study design.…”

“…Recent studies suggest that hydrocortisone (HC) may be a safer alternative to dexamethasone for the treatment of refractory hypotension in the preterm infant. 6,[16][17][18] The purpose of this pilot study was to further clarify the role of adrenal insufficiency in the pathogenesis of hypotension in ELBW infants, and to determine if early replacement therapy would improve blood pressure, thereby, reducing the need for vasopressor therapy in this population.…”