Evidence · Systematic review or meta-analysis
Timing of hydrocortisone therapy in neonates with shock: a systematic review, meta-analysis, and clinical practice guideline.
- Cardiovascular
- Medical
- Necrotising enterocolitis
- Shock and hypotension
Summary
This systematic review and meta-analysis compares earlier versus later initiation of hydrocortisone in neonates with shock, including 20 studies (7 RCTs and 13 non-RCTs), with GRADE-based certainty assessment and an accompanying clinical practice guideline. Early hydrocortisone in vasopressor-requiring shock appeared to be associated with better outcomes without major adverse effects. Later initiation may improve treatment response but may be associated with increased mortality and NEC. Evidence certainty was predominantly very low, so findings should be interpreted with caution.
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- Open (Creative Commons)
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