Oliguria during hydrocortisone dosage wean in very low birth weight infants

Am J Perinatol. 2014 Sep;31(8):673-6. doi: 10.1055/s-0033-1357264. Epub 2013 Oct 9.

Abstract

Background: Intravenous hydrocortisone (HC) is often used in very low birth weight infants (VLBW) but can be complicated by oliguria when discontinued or tapered.

Objectives: To determine which factors were associated with oliguria during HC taper.

Methods: We reviewed all VLBW infants who received initial doses of HC ≥ 1 mg/kg/d. The initial dose and duration of HC, and the incidence of oliguria (urine output [UO] < 2 mL/kg/h) during HC taper, were recorded. In those with oliguria, we recorded the change in UO (mL/kg/h), blood pressure, and creatinine.

Results: The mean initial HC dose was 2.8 ± 1 mg/kg/d, and the mean total duration of HC therapy was 23 ± 25 days. Oliguria occurred in 24% (13/54) of treated infants. These infants were exposed to higher and longer duration of the initial HC dose than infants without oliguria. Oliguria was predicted by the initial HC dose (odds ratio [OR] 5.8, 95% confidence interval [CI] 1.3-25.8, p = 0.02) and by the number of days at initial dose (OR 1.7, 95%CI 1.1-2.7, p = 0.03).

Conclusions: Oliguria during HC dosage weaning was associated with higher initial HC exposure.

MeSH terms

  • Adrenal Insufficiency / chemically induced*
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects*
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / adverse effects*
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal
  • Male
  • Oliguria / chemically induced*
  • Retrospective Studies
  • Substance Withdrawal Syndrome / etiology*

Substances

  • Anti-Inflammatory Agents
  • Hydrocortisone