Low-dose hydrocortisone in pediatric septic shock: an exploratory study in a third world setting

Harsha T Valoor, Sunit Singhi, M Jayashree
Pediatric Critical Care Medicine 2009, 10 (1): 121-5

OBJECTIVE: To study the efficacy of low-dose intravenous hydrocortisone therapy in the management of pediatric septic shock with respect to the time taken for shock reversal and requirement of inotropes.

DESIGN: Open label randomized pilot study.

SETTING: Pediatric intensive care unit of a tertiary care pediatric center in a third world country.

PATIENTS: Thirty-eight children, 2 months-12 yrs of age, with septic shock unresponsive to fluid therapy alone.

INTERVENTION: Intravenous hydrocortisone 5 mg/kg/day in four divided doses followed by half the dose for a total duration of 7 days or normal saline (similar amount in a similar manner) for the same duration.

RESULTS: There was a trend toward earlier reversal of shock (median 49.5 vs. 70 hrs, p = 0.65, Mann-Whitney U test) and lower inotropes requirement (median {lsqb;10th-90th centile{rsqb; inotropes score: 20 {lsqb;15-60{rsqb; vs. 50 {lsqb;20-80{rsqb;, p = 0.15) in the hydrocortisone-treated patients as compared with controls, although the difference was not statistically significant. Mortality rate was similar in both groups.

CONCLUSIONS: Our data, although, inconclusive favor the need for a study with a larger sample size to clearly define role of low-dose hydrocortisone in pediatric septic shock in developing countries, while taking in consideration effect of malnutrition, delayed presentations, and their interactions with the hypothalamic-pituitary-adrenocortical axis.

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