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

Background: Preterm infants with severe bronchopulmonary dysplasia require rescue therapy with glucocorticoids, and hydrocortisone is increasingly replacing dexamethasone. The standard for rescue therapy is unclear.

Aim: To quantify the short-term effects of respiratory rescue hydrocortisone of 4 mg/kg/day for 3 days.

Study Design: Retrospective single-center study.

Subjects: Ventilator-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 Measures: Ventilator settings, SpO/FiO ratio, heart rate, and blood parameters within 24 h before and 228 h after starting hydrocortisone.

Results: Twenty-five infants (median gestational age, 25.1 weeks) received hydrocortisone at a median age of 16 days. The median pre-therapy SpO/FiO was 297 (interquartile range, 265-320) and began to rise after 12 h of administration, reaching 307 (interquartile range, 278-335). The increase in SpO/FiO peaked from the third day to 3 days after therapy (median range, 341-356). SpO/FiO decreased thereafter and remained unchanged from 6 and 7 days after therapy (median range, 304-314). The pCO 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.

Conclusion: Rescue hydrocortisone administration improved oxygenation without particular adverse effects at the stage of respiratory deterioration in preterm infants.