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(2)/FiO(2) 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(2)/FiO(2) 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(2)/FiO(2) peaked from the third day to 3 days after therapy (median range, 341-356). SpO(2)/FiO(2) decreased thereafter and remained unchanged from 6 and 7 days after therapy (median range, 304-314). The pCO(2) 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.