Longitudinal Study of Plasma Cortisol and 17-Hydroxyprogesterone in Very-Low-Birth-Weight Infants during the First 16 Weeks of Life

Arnold, John D.; Leslie, Garth I.; Bowen, Jennifer R.; Watters, Sall; Kreutzmann, D; Silink, Martin

doi:10.1159/000244478

Cited by 15 publications

(11 citation statements)

References 14 publications

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“…The cortisol concentrations were compatible with previous findings in infants beyond the first week of life (12,(21)(22)(23), but contrary to the expectation that critically ill patients should have higher cortisol concentrations than normal individuals (24). However, we also found that infants diagnosed with AOP had significantly higher accumulation of cortisol precursors, suggesting limited 3␤-HSD activity.…”

Section: Discussionsupporting

confidence: 87%

Comparison of Serum Cortisol Concentrations in Preterm Infants With or Without Late-Onset Circulatory Collapse due to Adrenal Insufficiency of Prematurity

et al. 2008

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A recent survey found that approximately 4% of very low birth weight infants in Japan were treated with glucocorticoids postnatally for circulatory collapse thought to be caused by late-onset adrenal insufficiency. We identified 11 preterm infants with clinical signs compatible with this diagnosis (hypotension, oliguria, hyponatremia, lung edema, and increased demand for oxygen treatment) and matched them for gestational age with 11 infants without such signs. Blood samples were obtained for cortisol and its precursors from the patient group before the administration of hydrocortisone, and from the control group during the same postnatal week. All samples were analyzed using a gas chromatography-mass spectrometry system. Cortisol concentrations did not differ between the two groups (6.6 Ϯ 4.5 vs 3.4 Ϯ 2.7 g/dL); however, the total concentration of precursors in the pathway to cortisol production was significantly higher in the patient group (72.2 Ϯ 50.3 vs 25.0 Ϯ 28.5 g/dL; p Ͻ 0.05). We conclude that the clinical picture of late-onset adrenal insufficiency in preterm infants is not a result of an absolute deficiency of cortisol production, but may be a result of a limited ability to synthesize sufficient cortisol for the degree of clinical stress. A ccording to a recent nationwide survey in Japan, about 4% of very low birth weight (VLBW) infants are treated with postnatal steroids because of adrenal insufficiency of prematurity (AOP). This condition was defined in the survey as postnatal steroid usage during a hospital stay for treatment of late-onset circulatory collapse in premature infants (1). Reports on glucocorticoid-responsive hypotension among VLBW infants in the early postnatal period suggest that the hypothalamus-pituitary-adrenal system does not function sufficiently in the immediate postnatal period (2-7), and, as a result, the serum cortisol level is relatively low during the first week of life (8 -13). However, it has been suggested that this adrenal insufficiency in preterm infants is transient and that adrenal function tends to return to normal by the end of the second week of life (14). Two randomized control trials have demonstrated the benefit of glucocorticoids for preventing and treating refractory hypotension during the first week of life in VLBW infants (15,16). Therefore, glucocorticoid-responsive hypotension was not considered a common phenomenon beyond the first week of life in this population. However, VLBW infants sometimes develop late-onset glucocorticoid-responsive circulatory collapse.The purpose of the current study differs from previous reports on the above pathophysiological etiologies, because we focused specifically on late-onset circulatory instability, which is usually prominent after the first week of life in preterm infants. AOP was defined as postnatal steroid treatment for late-onset (after the first week of life) adrenal insufficiency in premature infants. To elucidate the pathogenesis of this disorder, a comparison of steroid hormone concentrations between ...

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Section: Discussionsupporting

confidence: 87%

Comparison of Serum Cortisol Concentrations in Preterm Infants With or Without Late-Onset Circulatory Collapse due to Adrenal Insufficiency of Prematurity

et al. 2008

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“…We do not have measurements of corticosteroid-binding globulin (CBG), but the literature suggests that CBG levels at this stage in development are low [26][27][28]. Plasma F fell with PCA, as previously observed [29,30]. This fall in F with increasing maturity is in contrast to the late gestational rise in plasma F seen in the fetus [31], which in utero may be due to increasing placental production of CRF.…”

Section: Discussionmentioning

confidence: 75%

Plasma Cortisol, Cortisone and Urinary Glucocorticoid Metabolites in Preterm Infants

Midgley

Holownia²,

Smith³

et al. 2001

Neonatology

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Objective and Methods: In the fetal circulation, there is a low cortisol:cortisone (F:E) ratio (∼0.3) suggesting high activity of 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2). The circulating F:E ratio rises after birth in term infants, but little is known about infants born prematurely. Our hypothesis was that the low fetal plasma F:E ratio would persist in infants born prematurely, due to persistently high tissue 11βHSD2 activity. To test this hypothesis, a longitudinal observational study of plasma F, E levels and urinary F and E metabolites was performed in 22 preterm infants of 24–31 weeks gestation. Results: Median plasma F was 234–380 nmol l^–1, median 124–177 nmol l^–1 from 1 to 14 days age. Plasma F fell with increasing postnatal and postconceptional age. The F:E ratio was 3 in the first week of life, and thereafter was 1–2, falling with postnatal age. Urinary glucocorticoid metabolites were low in quantity (∼48–120 µg kg^–1 day^–1), consisted of E metabolites until term, and did not reflect the plasma F:E ratio. Conclusions: The fetal plasma F:E ratio did not persist in these preterm infants, due to tenfold higher levels of F. The F:E ratios were similar to those reported in term infants. These data suggest that the low F:E ratio in utero is due to low fetal production of cortisol, and effective placental inactivation of maternal F by 11βHSD2.

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“…The infants in the current study did not require oxygen longer than 21 days and so may not have developed lung disease serious enough to interfere with the dyads' coregulation. In previous studies cortisol levels were influenced by gestational and postnatal age (Arnold et al, 1997;Bolt et al, 2002;Korte et al, 1996;Watterberg et al, 2001). These studies included infants born at less than 28 weeks' gestational age.…”

Section: Discussionmentioning

confidence: 99%

“…Bolt et al (2002) and Scott and Watterberg (1995) reported an inverse relationship between gestational age and cortisol levels in the first week of life such that infants born at an earlier gestational age have higher levels of cortisol than infants born more maturely. Other researchers have found decreasing cortisol levels from 1 to 16 weeks' postnatal age in preterm infants (Arnold et al, 1997;Heckmann et al, 2005). Postnatal age also has the potential to influence the relationship between sound level and cortisol reactivity.…”

Section: Potential Connections Among Characteristics Of the Sample Anmentioning

confidence: 95%

Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants

Neu

Laudenslager

Robinson

2008

Biological Research For Nursing

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The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother-infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.

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Longitudinal Study of Plasma Cortisol and 17-Hydroxyprogesterone in Very-Low-Birth-Weight Infants during the First 16 Weeks of Life

Cited by 15 publications

References 14 publications

Comparison of Serum Cortisol Concentrations in Preterm Infants With or Without Late-Onset Circulatory Collapse due to Adrenal Insufficiency of Prematurity

Comparison of Serum Cortisol Concentrations in Preterm Infants With or Without Late-Onset Circulatory Collapse due to Adrenal Insufficiency of Prematurity

Plasma Cortisol, Cortisone and Urinary Glucocorticoid Metabolites in Preterm Infants

Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants

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