From the Guidelines
A dose of 10 milligrams per kilogram of hydrocortisone in infants is likely to increase the risk of gastrointestinal bleeding, as it exceeds the typical therapeutic recommendations and has been associated with adverse effects such as gastrointestinal irritation, ulceration, and bleeding. The standard hydrocortisone dosing for infants typically ranges from 1-5 mg/kg/day for most indications, with higher doses reserved only for specific critical conditions like adrenal crisis 1.
Some key points to consider:
- High-dose hydrocortisone therapy has been associated with an increased incidence of gastrointestinal bleeding, particularly when administered for prolonged periods or in the presence of other risk factors such as coagulopathy or concurrent NSAID use 1.
- Hydrocortisone and other corticosteroids can reduce the protective mucus layer in the gastrointestinal tract and inhibit prostaglandin synthesis, which normally maintains mucosal integrity and blood flow 1.
- Low-dose hydrocortisone therapy (1 mg/kg per day) given for the first 2 weeks of life may increase rates of survival without BPD, particularly for infants delivered in a setting of prenatal inflammation, without adversely affecting neurodevelopmental outcomes 1.
- Clinicians should be aware of a possible increased risk of isolated intestinal perforation associated with early concomitant treatment with inhibitors of prostaglandin synthesis 1.
Given the potential risks associated with high-dose hydrocortisone therapy, it is essential to carefully weigh the benefits and risks of such treatment and to consider alternative therapies or dose regimens that may minimize the risk of adverse effects. If high-dose hydrocortisone is clinically necessary, gastric protection with medications like H2 blockers or proton pump inhibitors should be considered, and the infant should be monitored closely for signs of GI bleeding such as hematemesis, melena, or unexplained anemia 1.
From the Research
Dose of Hydrocortisone and G.I. Bleeding Risk
- The provided studies do not directly address the specific question of whether a dose of 10 milligrams per kilogram of hydrocortisone in infants is sufficient to increase the risk of gastrointestinal (G.I.) bleeding 2, 3, 4, 5, 6.
- However, a study from 2005 found that hydrocortisone treatment in infants with gestation ≤30 weeks, body weight of 501 to 1250 g, and respiratory failure, at doses from 2.0 to 0.75 mg/kg per day, was associated with an increased risk of gastrointestinal perforations 2.
- Another study from 2021 reported that corticosteroid bursts in children were associated with a 1.4- to 2.2-fold increased risk of G.I. bleeding within the first month after initiation of corticosteroid therapy 3.
- A study from 2001 found that patients using systemic corticosteroids had a relative risk of 4.2 for hospitalization due to upper gastrointestinal bleeding, compared to the general population 4.
- A systematic review protocol from 2018 aimed to assess the risk of G.I. bleeding in adult critically ill patients treated with corticosteroids, but did not provide specific results for infants or the dose of 10 milligrams per kilogram 5.
- A review from 2024 discussed the benefits and risks of prophylactic low-dose hydrocortisone in neonates born extremely preterm, including an increased risk of spontaneous intestinal perforation when combined with indomethacin, but did not address the specific dose of 10 milligrams per kilogram 6.
Key Findings
- The available evidence suggests that corticosteroid treatment, including hydrocortisone, may increase the risk of G.I. bleeding or perforation in certain populations, including infants and critically ill adults 2, 3, 4, 5, 6.
- However, the specific dose of 10 milligrams per kilogram of hydrocortisone in infants and its association with G.I. bleeding risk is not directly addressed in the provided studies.