{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:12:49Z","timestamp":1773371569642,"version":"3.50.1"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,10,1]]},"abstract":"<jats:p>OBJECTIVE. We sought to investigate whether the increase in blood pressure and decrease in vasopressor support after hydrocortisone administration are associated with changes in systemic hemodynamics in neonates who receive high-dosage dopamine to maintain blood pressure at the lowest acceptable levels.<\/jats:p><jats:p>METHODS. In this prospective, observational study, preterm and term neonates who required dopamine \u226515 \u03bcg\/kg per minute to maintain minimum acceptable blood pressure received intravenous hydrocortisone 2 mg\/kg followed by up to 4 doses of 1 mg\/kg every 12 hours. Fifteen preterm and 5 term neonates without a patent ductus arteriosus composed the study population. Echocardiograms and vascular Doppler studies were performed immediately before the first dose of hydrocortisone and at 1, 2, 6 to 12, 24, and 48 hours thereafter.<\/jats:p><jats:p>RESULTS. In the 15 preterm infants, during the first 12 hours of hydrocortisone treatment, the 28% increase in blood pressure paralleled that in the systemic vascular resistance without changes in stroke volume or cardiac output, whereas dopamine dosage decreased. By 24 hours, the dosage of dopamine continued to decrease, whereas stroke volume increased without additional changes in systemic vascular resistance. By 48 hours, dopamine dosage decreased by 72%; blood pressure and stroke volume increased by 31% and 33%, respectively; and systemic vascular resistance and cardiac output tended to be higher (14% and 21%, respectively) compared with baseline. Contractility, global myocardial function, and Doppler indices of blood flow in the middle cerebral and renal artery remained normal and unchanged. The findings in the 5 term infants showed a similar pattern for changes in cardiac function, systemic hemodynamics, and organ blood flow after hydrocortisone administration.<\/jats:p><jats:p>CONCLUSIONS. In preterm and term neonates who require high-dosage dopamine to maintain blood pressure at the lowest acceptable levels, hydrocortisone improves blood pressure without compromising cardiac function, systemic perfusion, or cerebral and renal blood flow.<\/jats:p>","DOI":"10.1542\/peds.2006-0661","type":"journal-article","created":{"date-parts":[[2006,10,2]],"date-time":"2006-10-02T17:04:22Z","timestamp":1159808662000},"page":"1456-1466","source":"Crossref","is-referenced-by-count":113,"title":["Hemodynamic Changes After Low-Dosage Hydrocortisone Administration in Vasopressor-Treated Preterm and Term Neonates"],"prefix":"10.1542","volume":"118","author":[{"given":"Shahab","family":"Noori","sequence":"first","affiliation":[{"name":"Divisions of Neonatal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Friedlich","sequence":"additional","affiliation":[{"name":"Divisions of Neonatal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Wong","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Pediatrics, Childrens Hospital Los Angeles and Women's and Children's Hospital, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmood","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Divisions of Neonatal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bijan","family":"Siassi","sequence":"additional","affiliation":[{"name":"Divisions of Neonatal Medicine"},{"name":"Cardiology, Department of Pediatrics, Childrens Hospital Los Angeles and Women's and Children's Hospital, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Istvan","family":"Seri","sequence":"additional","affiliation":[{"name":"Divisions of Neonatal Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2006,10,1]]},"reference":[{"key":"2021120822394084300_R1","doi-asserted-by":"crossref","unstructured":"Seri I. Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. J Pediatr.\u20081995;126:333\u2013344","DOI":"10.1016\/S0022-3476(95)70445-0"},{"key":"2021120822394084300_R2","doi-asserted-by":"crossref","unstructured":"Munro MJ, Walker AM, Barfield CP. Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics.\u20082004;114:1591\u20131596","DOI":"10.1542\/peds.2004-1073"},{"key":"2021120822394084300_R3","doi-asserted-by":"crossref","unstructured":"Young RS, Hernandez MJ, Yagel SK. Selective reduction of blood flow to white matter during hypotension in newborn dogs: a possible mechanism of periventricular leukomalacia. Ann Neurol.\u20081982;12:445\u2013448","DOI":"10.1002\/ana.410120506"},{"key":"2021120822394084300_R4","doi-asserted-by":"crossref","unstructured":"Watkins AM, West CR, Cooke RW. Blood pressure and cerebral hemorrhage and ischemia in very low birth weight infants. Early Hum Dev.\u20081989;19:103\u2013110","DOI":"10.1016\/0378-3782(89)90120-5"},{"key":"2021120822394084300_R5","unstructured":"Goldstein RF, Thompson RJ, Oehler JM, Brazy JE. Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants. Pediatrics.\u20081995;95:238\u2013243"},{"key":"2021120822394084300_R6","doi-asserted-by":"crossref","unstructured":"Grether JK, Nelson KB, Emery ES, Cummins SK. Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. J Pediatr.\u20081996;128:407\u2013414","DOI":"10.1016\/S0022-3476(96)70292-5"},{"key":"2021120822394084300_R7","doi-asserted-by":"crossref","unstructured":"Williams CE, Gunn AJ, Synek B, Gluckman PD. Delayed seizures occurring with hypoxic-ischemic encephalopathy in the fetal sheep. Pediatr Res.\u20081990;27:561\u2013565","DOI":"10.1203\/00006450-199006000-00004"},{"key":"2021120822394084300_R8","doi-asserted-by":"crossref","unstructured":"Pellicer A, Valverde E, Eloraza MD, et al. Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial. Pediatrics.\u20082005;115:1501\u20131512","DOI":"10.1542\/peds.2004-1396"},{"key":"2021120822394084300_R9","doi-asserted-by":"crossref","unstructured":"Seri I. Circulatory support of the sick newborn infant. In: Levene MI, Evans N, Archer N, eds. Seminars in Neonatology: Perinatal Cardiology. London, UK: WB Saunders; 2001;6:85\u201395","DOI":"10.1053\/siny.2000.0034"},{"key":"2021120822394084300_R10","doi-asserted-by":"crossref","unstructured":"Hunt RW, Evans N, Rieger I, Kluckow M. Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatr.\u20082004;145:588\u2013592","DOI":"10.1016\/j.jpeds.2004.06.056"},{"key":"2021120822394084300_R11","doi-asserted-by":"crossref","unstructured":"Tsuji M, Saul PJ, du Plessis A, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics.\u20082000;106:625\u2013632","DOI":"10.1542\/peds.106.4.625"},{"key":"2021120822394084300_R12","doi-asserted-by":"crossref","unstructured":"Gill AB, Weindling AM. Randomized controlled trial of plasma protein fraction versus dopamine in hypotensive very low birth weight infants. Arch Dis Child.\u20081993;69:284\u2013287","DOI":"10.1136\/adc.69.3_Spec_No.284"},{"key":"2021120822394084300_R13","doi-asserted-by":"crossref","unstructured":"Helbock HJ, Insoft RM, Conte FA. Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics.\u20081993;92:715\u2013717","DOI":"10.1542\/peds.92.5.715"},{"key":"2021120822394084300_R14","unstructured":"Tan R, Evans J, Seri I. Epinephrine increases blood pressure and urine output in preterm neonates with shock unresponsive to \u201cconventional\u201d doses of dopamine and dobutamine [abstract]. J Invest Med.\u20081999;47:179A"},{"key":"2021120822394084300_R15","doi-asserted-by":"crossref","unstructured":"Hausdorff WP, Caron MG, Lefkowitz RJ. Turning off the signal: desensitization of \u03b2-adrenergic receptors. FASEB J.\u20081990;4:2881\u20132890","DOI":"10.1096\/fasebj.4.11.2165947"},{"key":"2021120822394084300_R16","doi-asserted-by":"crossref","unstructured":"Collins S, Caron MG, Lefkowitz RJ. Regulation of adrenergic receptor responsiveness through modulation of receptor gene expression. Annu Rev Physiol.\u20081991;53:497\u2013508","DOI":"10.1146\/annurev.ph.53.030191.002433"},{"key":"2021120822394084300_R17","doi-asserted-by":"crossref","unstructured":"Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics.\u20082001;107:1070\u20131074","DOI":"10.1542\/peds.107.5.1070"},{"key":"2021120822394084300_R18","doi-asserted-by":"crossref","unstructured":"Tantivit P, Subramanian N, Garg M, Ramanathan R, deLemos RA. Low serum cortisol in term newborns with refractory hypotension. J Perinatol.\u20081999;19:352\u2013357","DOI":"10.1038\/sj.jp.7200202"},{"key":"2021120822394084300_R19","doi-asserted-by":"crossref","unstructured":"Scott SM, Watterberg KL. Effect of gestational age, postnatal age, and illness on plasma cortisol concentrations in premature infants. Pediatr Res.\u20081995;37:112\u2013116","DOI":"10.1203\/00006450-199501000-00021"},{"key":"2021120822394084300_R20","doi-asserted-by":"crossref","unstructured":"Korte C, Styne D, Merritt TA, Mayes D, Wertz A, Helbock HJ. Adrenocortical function in the very low birth weight infant: improved testing sensitivity and association with neonatal outcome. J Pediatr.\u20081996;128:257\u2013263","DOI":"10.1016\/S0022-3476(96)70404-3"},{"key":"2021120822394084300_R21","doi-asserted-by":"crossref","unstructured":"Ng PC, Lee CH, Lam CWK, et al. Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed.\u20082004;89:F119\u2013F126","DOI":"10.1136\/adc.2002.021972"},{"key":"2021120822394084300_R22","doi-asserted-by":"crossref","unstructured":"Fernandez E, Schrader R, Watterberg KL. Prevalence of low cortisol values in term and near-term infants with vasopressor-resistant hypotension. J Perinatol.\u20082005;25:114\u2013118","DOI":"10.1038\/sj.jp.7211211"},{"key":"2021120822394084300_R23","doi-asserted-by":"crossref","unstructured":"Watterberg KL, Gerdes JS, Cole CH, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics.\u20082004;114:1649\u20131657","DOI":"10.1542\/peds.2004-1159"},{"key":"2021120822394084300_R24","doi-asserted-by":"crossref","unstructured":"Noori S, Siassi B, Durand M, Acherman R, Sardesai S, Ramanathan R. Cardiovascular effects of low-dose dexamethasone in very low birth weight neonates with refractory hypotension. Biol Neonate.\u20082006;89:82\u201387","DOI":"10.1159\/000088289"},{"key":"2021120822394084300_R25","doi-asserted-by":"crossref","unstructured":"Gaissmaier RE, Pohlandt F. Single-dose dexamethasone treatment of hypotension in preterm infants. J Pediatr.\u20081999;134:701\u2013705","DOI":"10.1016\/S0022-3476(99)70284-2"},{"key":"2021120822394084300_R26","doi-asserted-by":"crossref","unstructured":"Ng PC, Lee CH, Bnur FL, et al. A double-blind, randomized, controlled study of a \u201cstress dose\u201d of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics.\u20082006;117:367\u2013375","DOI":"10.1542\/peds.2005-0869"},{"key":"2021120822394084300_R27","doi-asserted-by":"crossref","unstructured":"Seri I, Noori S. Diagnosis and treatment of neonatal hypotension outside the transitional period. Early Hum Dev.\u20082005;81:405\u2013411","DOI":"10.1016\/j.earlhumdev.2005.03.008"},{"key":"2021120822394084300_R28","doi-asserted-by":"crossref","unstructured":"Noori S, Seri I. Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev.\u20082005;81:399\u2013404","DOI":"10.1016\/j.earlhumdev.2005.03.007"},{"key":"2021120822394084300_R29","doi-asserted-by":"crossref","unstructured":"Wehling M. Specific, nongenomic actions of steroid hormones. Annu Rev Physiol.\u20081997;59:365\u2013393","DOI":"10.1146\/annurev.physiol.59.1.365"},{"key":"2021120822394084300_R30","doi-asserted-by":"crossref","unstructured":"Seri I. Hydrocortisone and vasopressor-resistant shock in preterm neonates. Pediatrics.\u20082006;117:516\u2013518","DOI":"10.1542\/peds.2005-2057"},{"key":"2021120822394084300_R31","doi-asserted-by":"crossref","unstructured":"Kluckow M, Evans N. Low superior vena cava flow and intraventricular hemorrhage in preterm infants. Arch Dis Child.\u20082000;82:188\u2013194","DOI":"10.1136\/fn.82.3.F188"},{"key":"2021120822394084300_R32","doi-asserted-by":"crossref","unstructured":"Kissack CM, Garr R, Wardle SP, Weindling AM. Cerebral fractional oxygen extraction in very low birth weight infants is high when there is low left ventricular output and hypocarbia but unaffected by hypotension. Pediatr Res.\u20082004;55:400\u2013405","DOI":"10.1203\/01.PDR.0000111288.87002.3A"},{"key":"2021120822394084300_R33","doi-asserted-by":"crossref","unstructured":"Nuntnarumit P, Yang W, Bada-Ellzey HS. Blood pressure measurements in the newborn. Clin Perinatol.\u20081999;26:981\u2013996","DOI":"10.1016\/S0095-5108(18)30030-7"},{"key":"2021120822394084300_R34","unstructured":"Zubrow AB, Hulman S, Kushner H, Falner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. J Perinatol.\u20081995;15:470\u2013479"},{"key":"2021120822394084300_R35","doi-asserted-by":"crossref","unstructured":"Rowland DG, Gutgesell HP. Noninvasive assessment of myocardial contractility, preload, and afterload in healthy newborn infants. Am J Cardiol.\u20081995;75:818\u2013821","DOI":"10.1016\/S0002-9149(99)80419-6"},{"key":"2021120822394084300_R36","doi-asserted-by":"crossref","unstructured":"Raju TNK. Cerebral Doppler studies in the fetus and the newborn infant. J Pediatr.\u20081991;119:165\u2013174","DOI":"10.1016\/S0022-3476(05)80722-X"},{"key":"2021120822394084300_R37","doi-asserted-by":"crossref","unstructured":"Greisen G, Johansen K, Ellison PH, Fredriksen PS, Mali J, Friis-Hansen B. Cerebral blood flow in the newborn: comparison of Doppler ultrasound and 133xenon clearance. J Pediatr.\u20081984;104:411\u2013418","DOI":"10.1016\/S0022-3476(84)81108-7"},{"key":"2021120822394084300_R38","doi-asserted-by":"crossref","unstructured":"Hansen NB, Stonestreet BS, Rosenkrantz TS, Oh W. Validity of Doppler measurements of anterior cerebral artery blood flow velocity: correlation with brain blood flow in piglets. Pediatrics.\u20081983;72:526\u2013531","DOI":"10.1542\/peds.72.4.526"},{"key":"2021120822394084300_R39","doi-asserted-by":"crossref","unstructured":"Noori S, Friedlich P, Seri I. Pharmacology review: the use of dobutamine in the treatment of neonatal cardiovascular. Neoreview.\u20082004;5:e22\u2013e26","DOI":"10.1542\/neo.5-1-e22"},{"key":"2021120822394084300_R40","doi-asserted-by":"crossref","unstructured":"Lopez SL, Leighton JO, Walther FJ. Supranormal cardiac output in the dopamine- and dobutamine-dependent preterm infant. Pediatr Cardiol.\u20081997;18:292\u2013296","DOI":"10.1007\/s002469900177"},{"key":"2021120822394084300_R41","doi-asserted-by":"crossref","unstructured":"Lodygensky GA, Rademaker K, Zimine S, et al. Structural and functional brain development after hydrocortisone treatment for neonatal chronic lung disease. Pediatrics.\u20082005;116:1\u20137","DOI":"10.1542\/peds.2004-1275"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/4\/1456\/1115430\/zpe01006001456.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/4\/1456\/1115430\/zpe01006001456.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T01:31:34Z","timestamp":1683595894000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/118\/4\/1456\/68980\/Hemodynamic-Changes-After-Low-Dosage"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,10,1]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2006,10,1]]},"published-print":{"date-parts":[[2006,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-0661","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,10,1]]}}}