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Oliguria during hydrocortisone dosage wean in very low birth weight infants

J B Sauberan1, E M Reed1, Y V Vaucher1

  • 1Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California.

American Journal of Perinatology
|October 11, 2013
PubMed

Insights

Higher initial doses of intravenous hydrocortisone (HC) in very low birth weight (VLBW) infants are linked to oliguria during HC tapering. This finding helps in managing HC dosage in VLBW infants to prevent reduced urine output.

Area of Science:

  • Neonatalogy
  • Pediatric Pharmacology
  • Critical Care Medicine

Background:

  • Intravenous hydrocortisone (HC) is a common treatment for very low birth weight (VLBW) infants.
  • Discontinuation or tapering of HC can lead to oliguria (reduced urine output) in VLBW infants.
  • Identifying factors associated with oliguria during HC taper is crucial for optimizing treatment.

Purpose of the Study:

  • To investigate the factors associated with the development of oliguria during the tapering of intravenous hydrocortisone in VLBW infants.
  • To determine the relationship between initial HC dosage, duration of therapy, and the incidence of oliguria.

Main Methods:

  • Retrospective review of VLBW infants receiving initial HC doses of ≥1 mg/kg/d.
  • Recording of initial HC dose, duration of HC therapy, and incidence of oliguria (urine output <2 mL/kg/h) during HC taper.
  • Analysis of urine output, blood pressure, and creatinine in infants who developed oliguria.

Main Results:

  • Oliguria occurred in 24% of the VLBW infants studied.
  • Infants experiencing oliguria had higher initial HC doses and longer exposure at the initial dose compared to those without oliguria.
  • The initial HC dose (OR 5.8) and duration at the initial dose (OR 1.7) significantly predicted oliguria.

Conclusions:

  • Higher initial exposure to hydrocortisone is associated with an increased risk of oliguria during dosage weaning in VLBW infants.
  • Clinical management should consider the initial HC dose and duration to mitigate the risk of oliguria.
  • Further research may explore specific thresholds for HC dosage and tapering strategies.
Abstract

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