Table 3.

Recommendations for weaning glucocorticoids (treatment >14 days).

Step 1	Convert current steroid dose to HC Eq dosea. If dose is >20 mg/m2/day, go to step 2. If dose is ≤20 mg/m2/day, change current steroid agent to hydrocortisone and go to step 4.
Step 2	Continue current steroid agent, decreasing dose by 50% every 3 days until a HC Eq dose of 15–20 mg/m2/day is reachedb, then go to step 3.
Step 3	Discontinue current steroid agent and change agent to hydrocortisone at a dose of 15–20 mg/m2/day divided twice daily for 3 days.
Step 4	Wean hydrocortisone to 8–10 mg/m2/day divided twice daily. Continue this dose for two weeks.
Step 5	If wean has been tolerated, discontinue hydrocortisone. Continue to monitor for adrenal insufficiency (hypoglycemia, hypotension, hyponatremia). Refer to Table 4 for post-wean management.

^aHC Eq dose, hydrocortisone equivalency dose (mg/m²/day).

^bIf the infant has any evidence of adrenal insufficiency during the wean, the dose can be increased back to the previously tolerated dose and the time between weans can be extended by an additional 3–6 days.