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. [Figure: see text] [Figure: see text]