Intensive care corticosteroids for critical neonatal conditions (review)

Abstract

Corticosteroids are widely used in clinical practice in the care of children in critical condition, but data on their efficacy in neonatal practice are very limited. This publication attempts to summarize and systematize the literature data on the use of exogenous corticosteroids in various diseases of the neonatal period. Special attention is paid to the pathophysiology of acute adrenal dysfunction in the structure of critical conditions, its diagnosis and treatment. The results of a number of studies confirming the effectiveness of various corticosteroids in neonatal cardiac surgery, arterial hypotension, neonatal sepsis, refractory septic shock, meconium aspiration syndrome and bronchopulmonary dysplasia are presented. It has been demonstrated that hydrocortisone is the drug of choice in critical situations due to its minimal half-life and low probability of side effects. It has been established that current data on the feasibility, efficacy and safety of corticosteroid use in critical conditions of the neonatal period are very controversial and require further experimental and clinical studies. The question of the necessity of corticosteroids use in neonatal cardiac surgery and in various lung diseases (meconium aspiration syndrome, bronchopulmonary dysplasia) remains open, although there is enough evidence of their positive therapeutic effect, but there are no randomized multicenter studies, which limits the use of corticosteroids in clinical practice. An absolute indication for the administration of corticosteroids in neonates is the presence of acute adrenal insufficiency, congenital adrenal cortical hyperplasia and catecholamine-resistant septic shock.