Pediatric Surgery International

, Volume 33, Issue 9, pp 981–987 | Cite as

Steroid use for refractory hypotension in congenital diaphragmatic hernia

  • Jason O. Robertson
  • Cory N. Criss
  • Lily B. Hsieh
  • Niki Matsuko
  • Josh S. Gish
  • Rodrigo A. Mon
  • Kevin N. Johnson
  • Samir K. Gadepalli
Original Article



Guidelines for diagnosis and treatment of adrenal insufficiency (AI) in newborns with congenital diaphragmatic hernia (CDH) are poorly defined.


From 2002 to 2016, 155 infants were treated for CDH at our institution. Patients with shock refractory to vasopressors (clinically diagnosed AI) were treated with hydrocortisone (HC). When available, random cortisol levels <10 μg/dL were considered low. Outcomes were compared between groups.


Hydrocortisone was used to treat AI in 34% (53/155) of patients. That subset of patients was demonstrably sicker, and mortality was expectedly higher for those treated with HC (37.7 vs. 17.6%, p = 0.0098). Of the subset of patients with random cortisol levels measured before initiation of HC, 67.7% (21/31) had low cortisol levels. No significant differences were seen in survival between the high and low groups, but mortality trended higher in patients with high cortisol levels that received HC. After multivariate analysis, duration of HC stress dose administration was associated with increased risk of mortality (OR 1.11, 95% CI 1.02–1.2, p = 0.021), and total duration of HC treatment was associated with increased risk of sepsis (OR 1.04, 95% CI 1.005–1.075, p = 0.026).


AI is prevalent amongst patients with CDH, but prolonged treatment with HC may increase risk of mortality and sepsis.


Adrenal insufficiency Stress dose Congenital diaphragmatic hernia Steroids 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Jason O. Robertson
    • 1
  • Cory N. Criss
    • 1
  • Lily B. Hsieh
    • 1
  • Niki Matsuko
    • 1
  • Josh S. Gish
    • 1
  • Rodrigo A. Mon
    • 1
  • Kevin N. Johnson
    • 1
  • Samir K. Gadepalli
    • 1
  1. 1.Section of Pediatric Surgery, C.S. Mott Children’s HospitalUniversity of MichiganAnn ArborUSA

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