Neonatal Hypotension, the Role of Hydrocortisone and Other Pharmacological Agents in its Management

Neonatal hypotension remains one of the most commonly encountered problems in neonatal intensive care units. Pharmacologic agents used in the management of neonatal hypotension include volume expanders, inotropes and vasopressors. Hydrocortisone can be used in resistant cases. Hydrocortisone acts both via genomic (slow) and non-genomic (fast) effects, however it is not recommended for urgent control of hypotension in neonates because its effects are usually delayed. Although the addition of hydrocortisone for the treatment of neonatal hypotension improves clinical outcomes, prolonged use of hydrocortisone may lead to suppression of the hypothalamic-pituitary axis and should be weaned gradually. Hydrocortisone in minimal dosages and for the shortest duration of therapy may prevent potential short and long-term side effects of its use.