• S Sarkar, R Dechert, R E Schumacher, and S M Donn.
• Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI 48109-0254, USA. subratas@med.umich.edu
• J Perinatol. 2007 Jun 1;27(6):353-8.

BackgroundClinicians frequently use hydrocortisone (HC) to treat vasopressor-resistant hypotension even before establishing its cause.ObjectiveTo identify the etiologic factors leading to development of refractory hypotension, and to assess if patent ductus arteriosus (PDA) is associated with refractory hypotension during the first week of life.Study DesignThe medical records of 290 consecutively born infants ResultsEighty-nine (30.7%) of 290 infants had refractory hypotension between postnatal days 2 and 7. Infants with refractory hypotension were more likely to have a lower birth weight and GA (P<0.001), been treated with surfactant (P=0.004) and received indomethacin for a symptomatic PDA (P<0.001). To identify the etiologic factors, a univariate analysis revealed that the use of high-frequency oscillatory ventilation, presence of air leaks, PDA, sepsis, hyperkalemia and intraventricular hemorrhage (IVH) were significantly associated with refractory hypotension. However, multivariate analysis confirmed the independent association of only PDA (odds ratio (OR) 7.6, 95% confidence interval (CI) 3.3-17.7, P=0.000), severe IVH (OR 2.6, 95% CI 1.1-6.4, P=0.03) and GA (OR 0.7, 95% CI 0.6-0.8, P=0.001).ConclusionsEvaluation for early ductal shunting and closure of the ductus, if patent, should be attempted before HC is considered in hypotensive infants with escalating needs for vasopressors.

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