Zapapas MK, et al. - Researchers conducted this retrospective chart review in order to delineate the utility of intravenous cosyntropin for refractory pediatric postdural puncture headache at a single free-standing tertiary care pediatric hospital. They retrospectively reviewed the charts of 26 cases who received 37 doses of cosyntropin over a 5-year period, for indication, dosing information, efficacy, and side effects. Patients were provided doses ranging from 5 to 15 mcg/kg (median, 10.4 mcg/kg). The first dose of cosyntropin led to a significant decrease in pain scores. They reported either a 50% reduction in pain or discharge within 24 hours after the first dose in 81% of patients (n = 21). The median time to discharge was 20 hours (range, 2 to 72 h) after the first dose. Treatment-related adverse effects were not identified. Findings support the possible utility of cosyntropin as a potential alternative to epidural blood patch for pediatric cases with postdural puncture headache who fail conservative management.