Adrenal Function in Sick Very Preterm Infants
- 1 November 2000
- journal article
- Published by Springer Nature in Pediatric Research
- Vol. 48 (5), 629-633
- https://doi.org/10.1203/00006450-200011000-00013
Abstract
Some very preterm neonates admitted to the neonatal intensive care unit show circulatory and respiratory problems that improve after administration of steroids. It is unclear whether these symptoms could be caused by adrenal insufficiency. The objective of our study was to investigate the cortisol levels and the cortisol release from the adrenals after ACTH in very preterm infants with and without severe illness and to find whether a relation exists between adrenal function and outcome. An ACTH test (0.5 μg) was performed on d 4 in 21 very preterm infants (gestational age, 25.6–29.6 wk; birth weight, 485–1265 g). Baseline cortisol and 17-hydroxyprogesterone (17OHP) levels and the cortisol levels 30, 60, and 120 min after ACTH administration were measured. The Score for Neonatal Acute Physiology was used to measure illness severity. All infants showed an increase in cortisol levels after ACTH, but the cortisol levels were significantly lower in the ventilated more severely ill infants. After adjusting for birth weight and gestational age, the mean baseline cortisol levels and cortisol/17OHP ratios were significantly lower and the 17OHP levels significantly higher in the ventilated infants compared with the nonventilated infants. Patients with an adverse outcome had significantly lower baseline cortisol/17OHP ratios and 60-min cortisol levels during ACTH testing (p = 0.002 and p = 0.03, respectively). These data suggest an insufficient adrenal response to stress in sick ventilated very preterm infants with gestational ages younger than 30 wk compared with nonventilated less sick preterm infants. Further studies are required to investigate whether supplementation with physiologic doses of hydrocortisone may benefit the outcome.Keywords
This publication has 30 references indexed in Scilit:
- Variability of Plasma Cortisol Levels in Extremely Low Birth Weight InfantsJournal of Clinical Endocrinology & Metabolism, 1997
- Corticosteroid Binding Globulin, Total Serum Cortisol, and Stress in Extremely Low-Birth-Weight InfantsAmerican Journal of Perinatology, 1997
- Adrenal steroidogenesis in very low birth weight preterm infantsJournal of Clinical Endocrinology & Metabolism, 1994
- Group B Streptococcal Sepsis in Piglets: Effect of Combined Pentoxifylline and Indomethacin PretreatmentPediatric Research, 1992
- Serum Adrenal Steroid Concentrations in Premature Infants*Journal of Clinical Endocrinology & Metabolism, 1989
- Adrenocortical Steroids in Small-for-Gestational-Age Term Infants during the Early Neonatal Period1,2Pediatric Research, 1989
- Plasma Mineralocorticoids, Glucocorticoids, and Progestins in Premature Infants: Longitudinal Study during the First Week of LifePediatric Research, 1988
- Adrenocortical reserve of neonates born of long-term, steroid-treated mothersEuropean Journal of Pediatrics, 1984
- Serum steroid levels in children at birth and in early neonatal periodAmerican Journal of Obstetrics and Gynecology, 1981
- Longitudinal Studies of Plasma Aldosterone, Corticosterone, Deoxycorticosterone, Progesterone, 17– Hydroxyprogesterone, Cortisol, and Cortisone Determined Simultaneously in Mother and Child at Birth and during the Early Neonatal Period. I. Spontaneous Delivery*Journal of Clinical Endocrinology & Metabolism, 1978