Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • severe inflammation, acute adrenal insufficiency, shock, hypoglycemia, simple allergic blood transfusion reactions, congenital adrenal hyperplasia


  • a steroid which possesses glucocorticoid activity with some mineralocorticoid effects
  • most effects likely result from modification of enzyme activity, thus affecting virtually all body systems
  • promotes protein catabolism, gluconeogenesis, renal excretion of calcium and red cell production; suppresses immune and inflammatory responses
  • the relative anti-inflammatory potency of hydrocortisone is 1/4 that of prednisone and about 1/30 that of dexamethasone
  • the relative mineralocorticoid activity of hydrocortisone is slightly greater (~20%) than that of prednisone; dexamethasone is virtually devoid of mineralocorticoid activity


  • gradually reduce drug dosage after continued use: DO NOT STOP ABRUPTLY
  • monitor infant's weight, blood pressure, serum electrolytes, serum and urinary glucose
  • may mask or exacerbate infections
  • do not confuse Solu-Cortef(R) with Solu-Medrol(R)
  • the potential for short and long term adverse neurological effects resulting from steroid use needs to be considered when using hydrocortisone


  1. Hypotension
    • 1 mg/kg IV q6h
    • most reports in the literature recommend initial therapy with volume expanders, then inotropes, before starting hydrocortisone
  2. Hypoglycemia
    • 1 to 2 mg/kg IV q8h
  3. Acute Adrenal Insufficiency
    • 1 to 2 mg/kg IV q6h
  4. Congenital Adrenal Hyperplasia
    • initial: 1 to 1.2 mg/kg/24h (divided 1/4 in am, 1/4 at noon, 1/2 at night (IV or po)
    • maintenance: 0.7 to 0.8 mg/kg/24h (divided as above)
  • in emergency situations give slow IV push; in other instances give by slow infusion

Side Effects

  • CVS: hypertension, fluid retention
  • GI: gastritis, GI hemorrhage
  • metabolic: hyperglycemia, hypernatremia, hypocalcemia, hypokalemia
  • skin: slow wound healing
  • increased predisposition to infection


  • 5 mg/ml patient specific syringes, prepared by Pharmacy
  • 50 mg/ml (when reconstituted, but dilute to 5 mg/ml before administering), 2 ml vial


  1. Seri I, Tan R, Evans J : Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001;107:1070-1074.
  2. Ng PC, Lam CW, Fok TF, Lee CH, Ma KC, Chan HIS, Wong E : Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed 2001;84:F122-F124.
  3. Helbock HJ, Insoft RM, Conte FA. Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics 1993;92:715-717.
  4. Bourchier D, Weston PJ : Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants. Arch Dis Child 1997;76:F174-F178.

Updated: 30 September 2002

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