AIM: To evaluate rectal hydrocortisone as an emergency glucocorticoid replacement therapy in adrenal insufficient children. METHODS: A parental questionnaire evaluated preferred treatment, problems or benefits of i.m. and rectal hydrocortisone, frequency and indications for administration and who administered treatment. Admissions of children with adrenal insufficiency were monitored. RESULTS: There were 39/52 families who responded to the questionnaire. 93% (26/28) preferred rectal hydrocortisone. Parents or children who previously received emergency treatment from a doctor now self-administered rectal hydrocortisone. The cost of suppositories and i.m. hydrocortisone is similar; however, storage of suppositories was inconvenient. One girl presented with pneumonia and collapse despite rectal hydrocortisone and a hydrocortisone level at admission of >2000 nmol/l with normal electrolytes. CONCLUSIONS: Rectal hydrocortisone is an acceptable and safe emergency therapy. We still advise i.m. hydrocortisone if rectal administration is not possible or with suppository extrusion.

Administration, Rectal↗

PubMedDate not supplied

The Dublin outcome for low birth-weight infants.

This report describes outcomes for all infants with birth weight 501-1750 grams born in the three major maternity hospitals in Dublin between 1.1.90 to 31.12.91. 37,958 mothers delivered 38,498 infants during this period, consisting of approximately 36% of all deliveries in Ireland. 633 (1.6%) of all infants born weighed 501-1750 grms. 102 (16%) were stillborn and 28 of the 531 live born infants had lethal malformations. 30% of women received two or more doses of antenatal steroids before delivery and a highly significant negative correlation occurred between the need for ventilation after birth and antenatal steroids. 56.4% of babies were delivered by caesarean section as compared with 10.8% of the hospital population. Of 503 liveborn infants without lethal malformation. 426 (85%) survived to 28 days and 419 (83%) to discharge home. 15% were growth retarded. 46% of infants were ventilated, mean duration of ventilation was 7 days. 25% of infants had an intraventricular haemorrhage, 10% necrotising enterocolitis and 19% culture proven sepsis. 15% of survivors developed broncho pulmonary dysplasia and 12% retinopathy of prematurity. This paper describes important information for mortality, morbidity and interventions among a large population of low birth weight infants in Ireland and can be used as a basis against which to compare future alterations in practice. It demonstrates a clear benefit for antenatal steroids in decreasing the need for ventilation and the importance of ensuring their utilisation antenatally where possible.

Female↗