Extremely low birth weight (ELBW) infants do not mount an adequate adrenocortical response to stress. Premature infants born following antenatal steroid therapy require less inotropic support to maintain their blood pressure during the early neonatal period, but this beneficial effect is transient. Critically ill ventilated ELBW infants often develop hypotension refractory to high dose inotropic agents during the first weeks of life. Hypotension is likely to contribute to the risk of ischemic brain injury among the survivors. While hydrocortisone (HC) has been used to treat hypotension in premature infants, such therapy has been associated with increased incidence of infections. We report our experience with using dexamethasone (Dex) or HC for hypotension and incidence of candida infection in 34 ELBW infants during a 2 year period. All infants were on high dose dopamine and dobutamine (10 - 20 mcg/kg/min) at the time of initiation of Dex or HC therapy. Results are Mean± SD. In all infants, inotropes could be weaned off within 12-48 hours after steroids. Serum cortisol levels were low and the levels did not correlate with the degree of hypotension. There were no significant differences in BW, GA, or other major risk factors for candida infection between the two groups. Candida infection developed in 1 infant in the Dex treated group, compared to 9 infants in HC treated group (p<0.009). We conclude that Dex may be preferred to HC in ELBW infants as this form of steroid is effective and the risk of candida infection is markedly reduced.Table

Table 1
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