Adrenocortical function in the very low birth weight infant: Improved testing sensitivity and association with neonatal outcome

Korte, Cindy; Styne, Dennis M.; Merritt, T. Allen; Mayes, Darrel M.; Wertz, Andrew; Helbock, Harold J.

doi:10.1016/s0022-3476(96)70404-3

Cited by 123 publications

(101 citation statements)

References 23 publications

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“…In adults, concentrations ranging from <5 mg per 100 ml 7 to 10 to 15 mg per 100 ml 32 have been considered insufficient during acute illness. In ELBW infants, a concentration of 5 mg per 100 ml has been more commonly used to represent adrenal insufficiency, 6,[8][9][10] and concentrations >15 mg per 100 ml have been used to represent adequate adrenal function. 10 However, previous reports document the notable variation in cortisol concentrations related to GA, birth weight, severity of illness and response to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In ELBW infants, a concentration of 5 mg per 100 ml has been more commonly used to represent adrenal insufficiency, 6,[8][9][10] and concentrations >15 mg per 100 ml have been used to represent adequate adrenal function. 10 However, previous reports document the notable variation in cortisol concentrations related to GA, birth weight, severity of illness and response to treatment. 6,8,9,13,16,22,29,33 -44 Considering this wide variation, our hope was to further clarify the usefulness of baseline cortisol concentrations to predict the degree of response to HC administration and help further identify infants with absolute and relative adrenal insufficiency based on pretreatment cortisol concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 By analogy to the concentrations used in adults and children, 7 adrenal insufficiency in newborns has been defined as a baseline serum cortisol concentration p5 mg per 100 ml. 6,[8][9][10] However, not all infants with 'low' cortisol values appear to be compromised, and conversely infants with concentrations in the normal range can have a clinical picture consistent with cardiovascular compromise secondary to adrenal insufficiency. This latter condition has been described as 'relative adrenal insufficiency' with cortisol concentrations that may be appropriate for normal functioning, yet are inadequate in the setting of acute illness or prematurity.…”

Section: Introductionmentioning

confidence: 99%

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Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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Objective: The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment.Study Design: This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 mg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC.Result: Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol.Conclusion: HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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“…In the intravenous dexamethasone group, basal cortisol levels were even lower than either inhaled group but similar to levels previously reported. 12,20 Cortisol levels in all three groups increased similarly following ACTH stimulation, but for each group, the mean response was blunted in comparison to that of historical controls. 19 Although there was a trend toward a greater response for infants within the inhaled groups, one must use caution in interpreting these results because approximately 30% of these infants crossed over to intravenous treatment.…”

Section: Discussionmentioning

confidence: 88%

A Randomized Trial of Inhaled Versus Intravenous Steroids in Ventilator-Dependent Preterm Infants

Suchomski

Cummings

2002

J Perinatol

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“…8,32,33 An additional aim of this study was to gather further evidence for the role of adrenal function, specifically cortisol production, in the maintenance of blood pressure. Our findings do not provide direct evidence for this role, as there was no apparent relationship between baseline cortisol levels and the presence of hypotension.…”

Section: Discussionmentioning

confidence: 99%

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

Efird

Heerens²,

Gordon

et al. 2004

J Perinatol

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Extremely low birth weight (ELBW) infants are at risk for hypotension. Abnormal adrenal function may play a role in the pathogenesis of hypotension, and therefore, the administration of hydrocortisone (HC) may be an effective treatment for hypotension in some infants. However, the efficacy of prophylactic HC to prevent the use of vasopressors for a defined hypotensive state has not been studied. We conducted a randomized-controlled trial to determine the potential role on adrenal insufficiency in early neonatal hypotension and to determine the effectiveness of prophylactic HC in reducing treatment of hypotension in ELBW infants. STUDY DESIGN:Infants were assigned to receive either HC or placebo within the first 3 hours of life. Therapy was continued for 5 days. The presence of hypotension was based on an operational definition and treatment with vasopressors (VP) was standardized based on an a priori protocol. RESULTS:A total of 34 patients were enrolled. Baseline characteristics were similar between groups. Of the HC group 25% received VP at 24 hours of age compared to 44% of the placebo group. On day of life 2, only 7% of the HC group received VP compared to 39% of the placebo group (p<0.05). CONCLUSION:Prophylactic treatment with HC reduces the incidence of hypotension, defined by treatment with VP, among ELBW infants during the first 2 days of life. However, the mounting evidence that prophylactic administration of glucocorticoids in the first days of life is harmful to ELBW infants makes HC prophylaxis unwise until the efficacy of treatment relative to safety can be clearly established.

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Adrenocortical function in the very low birth weight infant: Improved testing sensitivity and association with neonatal outcome

Cited by 123 publications

References 23 publications

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

A Randomized Trial of Inhaled Versus Intravenous Steroids in Ventilator-Dependent Preterm Infants

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

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