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

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.