Hydrocortisone Dosing for Infants with Acute Asthma Exacerbation
For infants with acute asthma exacerbation, the recommended dose of hydrocortisone is 1-2 mg/kg given intravenously every 6 hours for up to 48 hours. 1
Dosing Guidelines for Systemic Corticosteroids in Infants
- Initial IV hydrocortisone dose: 1-2 mg/kg every 6 hours (maximum 60 mg/day) 1
- Duration of IV therapy: Typically 24-48 hours until clinical improvement
- Follow-up oral therapy: Transition to oral prednisone/prednisolone at 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days total course 1
Evidence-Based Considerations
- Lower doses of hydrocortisone (1 mg/kg) have been shown to be as effective as higher doses (2 mg/kg) with fewer behavioral side effects 2
- Research has demonstrated that 5 mg/kg of hydrocortisone as a single dose can achieve therapeutic plasma levels for approximately 6 hours, supporting the every-6-hour dosing schedule 3
- There is no known advantage for higher doses of corticosteroids in severe asthma exacerbations 1
Route of Administration
- Intravenous administration is preferred initially for acute severe exacerbations
- Once the infant improves, transition to oral corticosteroids (prednisone/prednisolone)
- Note that there is no proven advantage of intravenous over oral therapy if gastrointestinal absorption is not impaired 1
Duration of Therapy
- Total course of systemic corticosteroids should last 3-10 days 1
- For courses less than 1 week, no tapering is needed
- For courses up to 10 days, tapering is generally not required, especially if the infant is concurrently taking inhaled corticosteroids 1
Important Clinical Considerations
Monitor for potential side effects, including:
Ensure concurrent appropriate bronchodilator therapy:
- Short-acting beta-agonists (albuterol/salbutamol)
- Consider adding ipratropium bromide for severe exacerbations 1
Common Pitfalls to Avoid
- Underdosing: Inadequate dosing may lead to poor symptom control and prolonged exacerbation
- Excessive dosing: Higher doses (>2 mg/kg) do not provide additional benefit but increase risk of side effects 5, 2
- Premature discontinuation: Ensure completion of the full course (3-10 days) to prevent relapse
- Failure to transition to maintenance therapy: Initiate or continue inhaled corticosteroids at any point during treatment of the exacerbation 1
Remember that systemic corticosteroids are a cornerstone of therapy for acute asthma exacerbations in infants, and early administration is critical for reducing morbidity and preventing progression to respiratory failure.