Hydrocortisone for hypotension and vasopressor dependence in preterm neonates: a meta-analysis.

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.