Corticosteroid Therapy in Neonatal Septic Shock—Do We Prevent Death?

Abstract

Objective The aim was to compare survival of patients with septic shock receiving or not hydrocortisone (HC) and to analyze the hemodynamic response to HC.

Study Design It is a retrospective study of 62 premature neonates with septic shock (confirmed bacteremia) and/or necrotizing enterocolitis (NEC) stage 2 and above receiving inotropes with or without HC. We analyzed survival and hemodynamic response to HC.

Results Thirty-nine (63%) premature neonates received HC and were compared with 23 (37%) who only received inotropes. Vasoactive index score (VAI) decreased and blood pressure, urine output, and oxygen requirements improved significantly following HC. Despite receiving more inotropes (VAI of 33 [20–53] vs 10 [8–20], p < 0.001), being more premature (26 ± 2 vs 27 ± 2 weeks, p = 0.02) and more frequently having NEC (64 vs 26%, p = 0.004), patients who received HC had similar survival from septic episode (death: 22% vs 41%, p = 0.12). However, patients receiving HC during their sepsis were less likely to survive at their 1-year postmenstrual age follow-up when accounted for gestational age (GA) at birth and duration of inotropes (hazard ratio 6.08 p = 0.01).

Conclusion HC was used in infants with increased inotropic support. HC during septic shock was associated with similar survival from episode, but with decreased survival at 1-year postmenstrual age.

Keywords

hydrocortisone - septic shock - hemodynamic profile - neonatal mortality - prematurity - relative adrenal insufficiency - necrotizing enterocolitis

Authors' Contributions

Gabriel Altit designed the protocol, did the data extraction and data analysis, and wrote the first draft of the manuscript. Myriam Vigny-Pau helped with data extraction. Veronique Dorval, Anie Lapointe. and Keith Barrington worked on protocol design and data analysis and approved the manuscript.

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