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Pediatric Surgery International
Published in: Pediatric Surgery International 9/2017

01-09-2017 | Original Article

Steroid use for refractory hypotension in congenital diaphragmatic hernia

Authors: Jason O. Robertson, Cory N. Criss, Lily B. Hsieh, Niki Matsuko, Josh S. Gish, Rodrigo A. Mon, Kevin N. Johnson, Samir K. Gadepalli

Published in: Pediatric Surgery International | Issue 9/2017

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Abstract

Purpose

Guidelines for diagnosis and treatment of adrenal insufficiency (AI) in newborns with congenital diaphragmatic hernia (CDH) are poorly defined.

Methods

From 2002 to 2016, 155 infants were treated for CDH at our institution. Patients with shock refractory to vasopressors (clinically diagnosed AI) were treated with hydrocortisone (HC). When available, random cortisol levels <10 μg/dL were considered low. Outcomes were compared between groups.

Results

Hydrocortisone was used to treat AI in 34% (53/155) of patients. That subset of patients was demonstrably sicker, and mortality was expectedly higher for those treated with HC (37.7 vs. 17.6%, p = 0.0098). Of the subset of patients with random cortisol levels measured before initiation of HC, 67.7% (21/31) had low cortisol levels. No significant differences were seen in survival between the high and low groups, but mortality trended higher in patients with high cortisol levels that received HC. After multivariate analysis, duration of HC stress dose administration was associated with increased risk of mortality (OR 1.11, 95% CI 1.02–1.2, p = 0.021), and total duration of HC treatment was associated with increased risk of sepsis (OR 1.04, 95% CI 1.005–1.075, p = 0.026).

Conclusion

AI is prevalent amongst patients with CDH, but prolonged treatment with HC may increase risk of mortality and sepsis.
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Metadata
Title
Steroid use for refractory hypotension in congenital diaphragmatic hernia
Authors
Jason O. Robertson
Cory N. Criss
Lily B. Hsieh
Niki Matsuko
Josh S. Gish
Rodrigo A. Mon
Kevin N. Johnson
Samir K. Gadepalli
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 9/2017
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-017-4122-3

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