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
