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  • Title: Low-dose hydrocortisone in pediatric septic shock: an exploratory study in a third world setting.
    Author: Valoor HT, Singhi S, Jayashree M.
    Journal: Pediatr Crit Care Med; 2009 Jan; 10(1):121-5. PubMed ID: 19057445.
    Abstract:
    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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