Cortisol and 17-a-hydroxy-progesterone levels in infants with refractory hypotension born at 30 weeks of gestation or less

Abstract

Refractory hypotension is frequent in very low-birth weight infants, whose hypothalamic-pituitary-adrenal axis has been suggested to be immature. The objective of the present study was to evaluate basal cortisol and 17-α-OH-progesterone in the first 36 h of life in preterm infants with and without refractory hypotension (mean arterial blood pressure below the lower limit for gestational age throughout the study despite aggressive volume expansion and use of vasopressors). Thirtyfive infants with ≤30 weeks of gestation and a birth weight ≤1250 g, with no postnatal use of corticosteroid or death in the first 48 h were studied. Mean arterial pressure was measured every 4 h during the first 48 h. Cortisol and 17-α-OH-progesterone were determined at 12 and 36 h and patients were divided into refractory hypotensive (N = 15) and control (N = 20) groups. The groups were not different regarding type of delivery, use of prenatal corticosteroid, requirement of mechanical ventilation, use of vasopressor drugs, morphine, fentanyl, prophylactic indomethacin, and mean sample timing. Although refractory hypotensive newborns were more immature, were smaller, suffered more deaths after 48 h of life and had a higher SNAPPE-2 score, their cortisol and 17-α-OH-progesterone levels were not different from controls at 12 h and at 36 h. The increase of cortisol in newborns with refractory hypotension 36 h after birth was significantly higher than in controls. Despite the fact that refractory hypotensive very low-birth weight neonates were submitted to a very stressful condition, their cortisol and 17-α-OH-progesterone levels were similar to controls.

Hyperdehydroepiandrosterone in neonates with hypoxic ischemic encephalopathy and circulatory collapse

“…It was found that cortisol and 17-hydroxy-progesterone levels were low in infants with refractory hypotension born less than 30 weeks of gestation. 27 We found that adrenal insufficiency also affects full term neonates under critical illness. More information on the development of adrenocortical function in neonates is still a needed, 28 and it continues to be difficult to give a precise diagnosis of corticosteroid insufficiency in patients with critical illnesses.…”

Expression of Free Cortisol in the Urine of Newborn in the First Days of Life

“…[15] у низцi дослiджень показали, що концентрацiя попередникiв глюкокортикоїдiв у передчасно народжених дiтей вища, нiж у доношених. Аналогiчнi данi одержали P. G. Martins, R. S. Procianoy [16], K. Masumoto, S. Kusuda [17], E. F. Fernandez, K. L. Watterberg [18]. Але в усiх зазначених дослiдженнях результати одержано при обстеженнi невеликої кiлькостi дiтей, аналiз проводився рiзними статистичними метода-ми, та були використанi рiзнi одиницi вимiру кортизолу.…”