Incidence of gastrointestinal bleeding with hydrocortisone use in neonates and infants less than three months of age in the neonatal intensive care unit

The objective of this study was to determine the incidence of hydrocortisone-associated gastrointestinal bleeding (GIB) in infants <3 months and compare rates with or without stress ulcer prophylaxis.

Retrospective cohort study of NICU patients <3 months who received hydrocortisone for hypotension. Three logistic regressions were conducted for adjusted associations between GIB, necrotizing enterocolitis (NEC), or infection and clinical characteristics.

Of 233 patients included, 54 (23.2%) received SUP; the majority (96.3%) received histamine-2 receptor antagonists. Median postmenstrual and postnatal age at hydrocortisone initiation was 33.3 weeks and 2 days. GIB occurred in 22 patients (9.4%), with no difference in GIB (11.1% versus 8.9%, p = 0.632) or SUP-associated adverse effects (50.0% versus 52.0%, p = 0.80) with and without SUP. SUP was not associated with GIB, NEC, or infection when controlling for confounders.

GIB occurred in 9.4% of patients. SUP did not provide benefit for GIB prevention and was not associated with increased risk of adverse effects.