174: Corticosteroid Therapy in Neonatal Management of Shock
Bibliographic record
Abstract
Controversy exists about the management of neonatal septic shock. Hydrocortisone (HC) is used during septic course in older children and adults, but has been rarely studied in neonates. To describe hydrocortisone administration in septic shock in our neonatal intensive care unit and determine if variations in practice are associated with improved survival. The effects of HC therapy for septic shock were retrospectively evaluated in neonates admitted to our unit between 2010 and 2013. Data regarding timing of HC administration and effects on survival were analysed. Thirty-five infants were treated for neonatal shock during the study period (80% culture proven sepsis). A total of 23 patients out of the 35 received HC during the course of their shock (average cumulative dose of 16±16 mg/kg). The two groups (hydrocortisone vs no-hydrocortisone) did not differ significantly in terms of gestational age (25.7±1.4 vs 26.8±1.8 weeks, P=0.68), birth weight (994±194 vs 964±371 grams, P=0.34) and age at onset of shock (12.2±18 vs 9.9±8.1 days, P=0.93). Exposure to antenatal steroids (87% vs 100%, P=054) and APGAR scores (6±2 and 6±2, P=0.69) did not differ significantly between the two groups. Patients who received hydrocortisone were less likely to survive (26 vs 83%, P=0.03) and were sicker in general (vasoactive index score 48±51 vs 10±8, P=0.000). Timing of hydrocortisone administration was on average 49±63 hours after the onset of shock. Although we noted a trend toward later hydrocortisone administration in survivors (79±92 vs 38±51 hours, P=0,26), this difference was not statistically significant. Patients that received hydrocortisone and survived had a trend toward a more prolonged hospitalisation (age at discharge 47.4±5.8 vs 42±5.3 weeks of corrected gestational age, P=0.08). In our centre, hydrocortisone administration in the context of neonatal septic shock tends to be early and in patients presenting with a more severe clinical picture. However, this is without any improvement in survival. Further prospective studies are needed to clarify hydrocortisone's role in septic shock management in the term and preterm newborn.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".