Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension

Mahdi Alsaleem; Aysha Malik; Satyan Lakshminrusimha; Vasantha Hs Kumar

doi:10.1177/1179556519888918

Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension

Clin Med Insights Pediatr. 2019 Nov 21:13:1179556519888918. doi: 10.1177/1179556519888918. eCollection 2019.

Authors

Mahdi Alsaleem^{1

2}, Aysha Malik³, Satyan Lakshminrusimha⁴, Vasantha Hs Kumar⁵

Affiliations

¹ Children's Mercy Hospital, Kansas city, MO, USA.
² The University of Kansas, Wichita, KS, USA.
³ Internal Medicine and Pediatrics, The State University of New York, University at Buffalo, Buffalo, NY, USA.
⁴ Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA, USA.
⁵ Depatment of Pediatrics, Division of Neonatal-Perinatal Medicine, The State University of New York, University at Buffalo, Buffalo, NY, USA.

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is an essential cause for hypoxic respiratory failure with significant morbidity and mortality in term and near-term neonates. Hydrocortisone has been shown to decrease oxygen dependency and pulmonary hypertension in neonates with meconium aspiration syndrome and animal studies, respectively. We hypothesize that hydrocortisone will improve oxygenation in term and near-term infants with pulmonary hypertension. We performed a retrospective chart review of all infant with PPHN who received intravenous hydrocortisone therapy as a rescue for severe PPHN. Clinical response was objectively measured using, oxygenation index (OI), PaO₂/FiO₂ ratio, and inotrope score before, during, and after the hydrocortisone course. We found that hydrocortisone administration resulted in significant improvement of systolic blood pressure, OI, and PaO₂/FiO_2. In conclusion, hydrocortisone increased systolic blood pressure and improved oxygenation in term and near-term infants with persistent pulmonary hypertension. Prospective randomized trials are required to evaluate these findings further.

Keywords: NICU; PPHN; hydrocortisone; infants; neonates; oxygenation index; steroids; systolic blood pressure.