Objective: The effect of HC on mean arterial blood pressure(MABP) was evaluated in a double-blind randomized study in 26 neonates with hypotension, despite high dose cardio-inotropics. Methods: 26 hypotensive neonates despite treatment with 20 μg/kg/min. dopamine and/or dobutamine, were randomized to receive either HC (5 mg/kg/day in 4 doses), or placebo (P). Hypotension was defined as MABP of less than nr. of gestational age in weeks in mmHg, during at least 30 minutes. During 24 hours MABP, heart rate, urine output, vasoactive medication and volume expanders were recorded.Results: Hypotension could be effectively treated within 24 hours in both HC- and P-treated neonates (table). No difference in additional vasoactive medication (dopamine, dobutamine, adrenaline or isoprenaline), or in volume expanders was found. However, in the HC-treated patients the increase in MABP to normal values occurred more rapidly (within 6 hours) than in the P-group (p<0.05). HC and P groups were comparable for gestational age and birth weight. No differences were found between groups for intracranial hemorrhage (7HC/7P) or flaring(5HC/5P).

Table 1 No caption available.
Full size table

Conclusion: 1. Rapid increase in MABP to normotension after 1 dose of 1.25 mg/kg HC in hypotensive neonates, treated with 20 μg/kg/min. dopamine and/or dobutamine. 2. Equal occurrence of cerebral complications in HC- and P-treated neonates. 3. Early administration of HC in low birth weight neonates with hypotension might be more beneficial than increasing the dosage of cardio-inotropics.

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