92 Systemic corticosteroids in neonates with septic shock: A systematic review
Bibliographic record
Abstract
Abstract Background Neonatal septic shock is associated with a high risk of mortality. Corticosteroids are frequently used as a rescue therapy in septic shock refractory to vasoactive medications. While there is a strong rationale for the use of corticosteroids in neonatal septic shock, evidence to guide this clinical practice has not been consolidated. Objectives To systematically review the efficacy and safety of systemic corticosteroids in neonates with septic shock refractory to vasoactive medications. Design/Methods MEDLINE, Cochrane, Embase, PubMed, CINAHL, Scopus, and Google Scholar were searched until May 2024 for studies evaluating the efficacy and safety of corticosteroid use in neonates with septic shock. Our protocol was registered on PROSPERO beforehand (ID CRD42024550634). Results We screened 7195 abstracts and assessed 65 full text articles. Two retrospective cohort studies evaluating a total of 1654 neonates were included. Systemic hydrocortisone (HC) was associated with a significantly shorter duration of septic shock [median (interquartile range) 97 hours (34, 228) vs 36 (18, 119)] in one study. Neonates on HC received higher doses of vasopressor and had longer stays in hospital in both studies. Contradictory results were found regarding mortality in the NICU; one study found a non-significant increase in death at discharge with HC use, while the other showed a decreased mortality in the HC group (aOR of mortality = 0.60 (0.42-0.86)). Patients on HC had increased mortality at 1-year follow-up when adjusted for gestational age and inotrope duration in one study (HR 6.08, p = 0.01). Neither article suggested an exact threshold to start HC in refractory hypotension. Conclusion The literature behind the use of corticosteroids in neonatal septic shock refractory to vasoactive medications is limited. This strongly supports the need for more focused research to ascertain their efficacy and side effect profile in septic shock among neonates.
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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 | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
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".