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Urinary free cortisol (UFC) values in newborns under stress
Insights
Neonatal stress increases urinary free cortisol (UFC) output significantly, approximately 4.5 times higher in sick infants. This study confirms a distinct diurnal variation of UFC in neonates, even during illness.
Area of Science:
- Pediatric Endocrinology
- Neonatal Physiology
- Stress Response
Background:
- Children with adrenocortical insufficiency require stress-related glucocorticoid dose adjustments.
- Current recommendations suggest a 3-5 fold increase in glucocorticoid replacement during stress.
Purpose of the Study:
- To assess actual urinary free cortisol (UFC) output changes during stress in neonates.
- To investigate the effect of stress on diurnal cortisol variation in neonates.
Main Methods:
- Measured 24-hour UFC excretion in 75 neonates (30 healthy, 45 with respiratory distress) within the first two days of life.
- Collected UFC in 6-hour fractions for 60 infants to analyze diurnal variation.
Main Results:
- Sick neonates exhibited a mean UFC increase 4.5 times higher than healthy controls.
- A clear diurnal variation in UFC was observed in both healthy and sick neonates.
Conclusions:
- Contrary to some prior research, a distinct diurnal cortisol pattern was evident in most neonates studied.
- Findings suggest stress significantly impacts UFC levels and diurnal patterns in neonates.
Unlabelled:
Children with adrenocortical insufficiency are commonly instructed to increase three to five times baseline glucocorticoid replacement dose during periods of stress such as surgery or febrile illness. The present study was undertaken to determine whether these recommendations reflect the actual change in urinary free cortisol (UFC) output during stress in neonates and to test the effect of stress on the diurnal variation of cortisol in this age group.
Design And Patients:
Twenty-four hour urinary free cortisol (UFC) excretion was determined in 75 neonates during the first 2 days of life. Thirty were healthy and 45 were neonates with respiratory distress. In 60 babies the 24-h UFC was collected in 6-h fractions for the determination of diurnal variation of urinary cortisol.
Results:
The mean change in UFC was 4.5 times higher in the sick babies than in the controls. A distinct diurnal variation of UFC was noted in both healthy and sick babies.
Conclusions:
In contrast with previous publications a distinct diurnal pattern was noted in the majority of neonates.