Hydrocortisone Stress dose: 2-6 mg/kg/day, physiologic replacement 1-2 mg/kg/day.
Dose may be divided q12hrs. It has a more physiologic half-life and agent is
eliminated from body within 24hrs of dosing. This agent has been utilized in both
treating the steroid deficient infant and supplementing the stressed premature infant.
Methylprednisolone (Solu-Medrol) Loading dose is 1-2 mg/kg IV. Subsequent dosing is
2 mg/kg IV divided in to 4 doses. This agent is more commonly used in older premature
infants, who are ventilator dependent secondary to severe CLD, and currently during
hospitalization when evaluation for possible tracheostomy.
Inhaled steroids may play a role in decreasing CLD. Beclomethasone has limited
systemic effects.
V. INTRAVENTRICULAR HEMORRHAGE (IVH)
While the overall incidence has fallen sharply in the last 20 years, the incidence is 5-
11%. IVH is more common in preterm infants and its incidence is directly proportional
to the degree of prematurity (e.g., 45% in infants born at 500-749 grams). Studies
have shown that 450 % of all IVH occur within the first 24 postnatal hours of age and
78% within the first 72 hours. These infants are at increased risk for seizures,
hydrocephalus, and death. Surviving infants may have neurodevelopmental and
cognitive difficulties.