Mizobuchi M, Nakao H, Fujioka K (2014) Rescue Glucocorticoid Therapy In Extremely Preterm Infants. Int J Pediat Health Care Adv. 1(1), 1-3 1 http://scidoc.org/IJPA.php International Journal of Pediatric Health Care & Advancements (IJPA) ISSN 2572-7354 Rescue Glucocorticoid Therapy in Extremely Preterm Infants Review Article Masami Mizobuchi 1 , Hideto Nakao 1 , Kazumichi Fujioka 2* 1 Department of Neonatology, Hyogo Prefectural Kobe Children’s Hospital Perinatal Center, 1-1-1, Takakuradai, Suma-ku, Kobe 654–0081, Japan. 2 Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building, Rm S230, Stanford, CA 94305-5208, USA. *Corresponding Author: Kazumichi Fujioka, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building, Rm S230, Stanford, CA 94305-5208, USA. Tel: 650-248-1667 E-mail: fujiokak@stanford.edu Received: October 27, 2014 Accepted: December 16, 2014 Published: December 18, 2014 Citation: Mizobuchi M, Nakao H, Fujioka K (2014) Rescue Glucocor- ticoid Therapy In Extremely Preterm Infants. Int J Pediat Health Care Adv. 1(1), 1-3. doi: http://dx.doi.org/10.19070/2572-7354-140001 Copyright: Fujioka K © 2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Despite the recent improvement in survival in extremely low gestational age newborns (ELGAN), postnatal refractory hypo- tension and chronic lung disease (CLD) are still common com- plications of ELGAN, and are associated with devastating neu- rodevelopmental outcomes [1]. Although the pathophysiology of these morbidities has not been fully clariied, the potential contri- bution of relative adrenal insuficiency in preterm newborns to the development of refractory hypotension and CLD has been suggested [2]. Based on this possibility, a series of glucocorticoid (GC) therapies for ELGAN have been investigated,but the efi- cacy and safety of GC for morbidity are still unclear [3-5]. In this mini review, we focus on the rescue use (not prophylactic use) of GC for postnatal refractory hypotension and CLD in ELGAN, and review our clinical practices. Rescue GC Therapy for Refractory Hypotension Refractory hypotension commonly occurs in premature new- borns. Refractory hypotension is associated with a high mortality rate, an increased incidence of intraventricular hemorrhage and periventricular leukomalacia, and poor neurodevelopmental out- comes. However, the etiology of refractory hypotension is not fully understood [6-10]. Our research group and others have re- cently focused on “relative adrenal insuficiency”, as the basis of refractory hypotension in ELGAN [11]. This research is based on indings of an inverse relationship between plasma cortisol levels and gestational age [12], and an insuficient response to stress in sick, ventilated, very preterm infants [13]. There are several ret- rospective trials regarding rescue GC therapy to treat neonatal refractory hypotension [14-16]. However, there are insuficient numbers of well-designed randomized controlled trials (RCTs) regarding GC therapy for refractory hypotension in preterm in- fants [3]. Among the four RCTs included in a recent Cochrane Review [3], Gaissmaier et al. used dexamethasone (DEX) [17] and Ng et al. used hydrocortisone (HC) [18] are intended to treat early neonatal refractory hypotension by GC therapy. The authors in both of the trials concluded that GC therapy signiicantly re- duced the use of inotropes in the management of refractory hy- potension. However, their study designs were not suficient to determine the safety of rescue use of GC. With regard to studies using HC as the primary treatment of hypotension (not for hy- potension unresponsive to inotropes), Bourchier et al. compared HC versus dopamine in a randomized controlled manner with a relatively small sample size, and found no signiicant advantage of HC against dopamine use [19]. Hochwald et al. investigated the combinational therapy of HC with dopamine against placebo with dopamine in a RCT, and found no signiicant differences in eficacy and safety between the groups [20]. Abstract Refractory hypotension and chronic lung disease are common and lethal complications in extremely low gestational age newborns. Recently, glucocorticoids have been used as rescue therapy for these diseases based on the proposed contribution of relative adrenal insuficiency. However, the eficacy and safety, and optimal treatment protocol of glucocorticoids have not been established. We recently reported the potency of our therapeutic protocol for postnatal refractory hypotension with a single low dose of hydrocortisone. We also reported the eficacy of our therapeutic protocol with hydrocortisone for severe leaky lung syndrome, which occurs in the progression phase of chronic lung disease. To determine the eficacy and safety of these strategies, further well-designed randomized controlled trials are necessary. Keywords: Glucocorticoid; Extremely Preterm Infants; Refractory Hypotension; Chronic Lung Disease.