Document Detail


Hydrocortisone for hypotension and vasopressor dependence in preterm neonates: a meta-analysis.
MedLine Citation:
PMID:  19693023     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A full consensus has not been reached about the hemodynamic efficacy of hydrocortisone administration in hypotensive and vasopressor-dependent preterm neonates. OBJECTIVE: To examine the efficacy of hydrocortisone for treatment of hypotension and reduction of vasopressor requirements in preterm infants. METHOD: Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels. RESULT: Random effects meta-analysis showed that hydrocortisone increases blood pressure (seven studies; N=144; r=0.71, 95%CI=0.18 to 0.92) and reduces vasopressor requirement (five studies; N=93; r=0.74, 95%CI=0.0084 to 0.96). The number of new or unretrieved studies averaging null results required to increase the overall p to 0.05 is k=78 for blood pressure increase and k=47 for vasopressor requirement reduction. CONCLUSION: The effects of hydrocortisone on increasing blood pressure and decreasing vasopressor requirements in preterm infants are robust with a large tolerance for future null results. Actual clinical benefits of increasing blood pressure and decreasing vasopressor requirements, however, remain unknown. Long-term sequelae of hydrocortisone administration have yet to be fully elucidated.
Authors:
S Higgins; P Friedlich; I Seri
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Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2009-08-20
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  30     ISSN:  1476-5543     ISO Abbreviation:  J Perinatol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-28     Completed Date:  2010-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-8     Citation Subset:  IM    
Affiliation:
Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Adrenal Insufficiency / drug therapy*,  physiopathology
Cardiotonic Agents / therapeutic use
Humans
Hydrocortisone / therapeutic use*
Hypotension / drug therapy*,  physiopathology
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / drug therapy*
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Cardiotonic Agents; 0/Vasoconstrictor Agents; 50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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