Refractory hypotension in preterm infants with adrenocortical insufficiency

Five preterm, very low birthweight infants with severe hypotension and adre nocortical insufficiency are described. The profound hypotension was resist ant to volume expansion and inotrope treatment, but responded promptly to c orticosteroid treatment. A human corticotrophin releasing hormone (hCRH) te st performed before corticosteroid treatment showed adequate pituitary resp onse, and the endocrine dysfunction was identified at the adrenal level. Co rticosteroid treatment should be considered and could be life saving in sev erely hypotensive preterm infants who do not respond to conventional treatm ent with volume expanders and inotropes.