Background Hydrocortisone is now prescribed frequently to treat hypotension in the very low birth weight (VLBW) infant.

Objective (1) To assess the relationship between superior vena cava (SVC) flow, mean blood pressure (MBP) and cortisol values. (2) To assess the correlation between cortisol values and clinical assessment of multi-organ dysfunction (using CRIB 2, SNAPPE 2 and NEOMOD scores) in first 24 h in VLBW infants.

Design/Methods A prospective observational cohort study. Neonates with birth weight less than 1500 g were eligible for enrollment. Echocardiographic evaluation of superior vena cava flow was performed in the first 24 h of life. Cortisol levels were measured simultaneously and appropriate clinical scores were calculated.

Results 54 VLBW neonates were enrolled following parental consent. Two patients were excluded for congenital malformations. In 14 babies the cortisol value was not simultaneously obtained. The mean birth weight was 1.08 kg, mean gestational age was 27.8. The correlation coefficient for SVC and cortisol was r  =  0.07 (p = 0.69), for MBP and cortisol was −0.19 (p = 0.28). The correlation coefficient for cortisol and clinical scores were CRIB 2 r  =  0.42 (p = 0.009), SNAPPE 2 r  =  0.38 (p = 0.02) and NEOMOD r  =  0.5 (p = 0.001).

Conclusions There was no correlation between SVC flow and cortisol values or between cortisol and MBP values. There was a good correlation between cortisol levels and all three clinical scores for severity of disease/multiorgan dysfunction. This suggests that stressed VLBW infants may mount a cortisol response.