Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically ill infants with congenital heart disease

Glucocorticosteroids may improve refractory hemodynamic instability in the systemic inflammatory response syndrome,(1,2) in which premature or stresse d neonates may have an inappropriate or abnormal adrenal response to stress .(3,4) Over the past 3 years we have attempted to use corticosteroids in in fants with congenital heart disease on high-dose epinephrine ( greater than or equal to0.15 mug/kg/min), particularly when inotropic requirements have continued to increase late after initial presentation or cardiac surgery. Our early observations in unstable neonates treated with glucocorticoids pr ovided the rationale for the hypothesis that steroids decrease inotropic re quirements in critically ill infants with congenital heart disease. This st udy retrospectively examined patients treated with steroids to determine wh ether steroid treatment was associated with significant reduction in epinep hrine dosage and/or improvement in hemodynamics.