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Comparison between low- and standard-dose ACTH tests in premature infants at risk for chronic lung disease
P Nykänen1, K Heinonen, R Voutilainen
1Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland. paivi.nykanen@uku.fi
Insights
Low-dose adrenocorticotropin (LD-ACTH) tests can evaluate adrenocortical function in premature infants. However, specific criteria for diagnosing adrenal insufficiency using LD-ACTH require further definition.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatric Pharmacology
Background:
- Premature infants often require interventions like dexamethasone therapy for chronic lung disease.
- Assessing adrenocortical function is crucial in this vulnerable population.
- Dexamethasone therapy can potentially impact the hypothalamic-pituitary-adrenal axis.
Purpose of the Study:
- To compare the sensitivity of low-dose (LD-ACTH) and standard-dose (SD-ACTH) adrenocorticotropin tests for evaluating adrenocortical function in premature infants.
- To assess adrenocortical response before and after dexamethasone therapy.
Main Methods:
- A comparative study involving 12 very-low-birth-weight infants.
- Administration of LD-ACTH (0.5 microg/1.73 m(2)) and SD-ACTH (250 microg/1.73 m(2)).
- Measurement of serum cortisol levels at 20 and 60 minutes post-ACTH administration, before and after dexamethasone therapy.
Main Results:
- Basal serum cortisol levels were found to be inappropriately low in several infants prior to dexamethasone treatment.
- Serum cortisol levels at 20 minutes showed similar responses between LD-ACTH and SD-ACTH.
- A significantly lower cortisol response was observed with LD-ACTH compared to SD-ACTH at 60 minutes.
Conclusions:
- Low-dose ACTH testing is a viable method for assessing adrenocortical function in premature infants, similar to older children and adults.
- The established criteria for adrenocortical insufficiency may need adjustment for LD-ACTH use in this population.
- Further research is needed to define specific diagnostic criteria for adrenocortical insufficiency using LD-ACTH in premature infants.
Abstract:
In order to find a sensitive method to evaluate adrenocortical function in premature infants, we compared low- (0.5 microg/1.73 m(2)) and standard-dose (250 microg/1.73 m(2)) adrenocorticotropin tests (LD- and SD-ACTH) in 12 very-low-birth-weight infants before and 2 days after the end of dexamethasone therapy (duration 9-14 days) for chronic lung disease. Basal serum cortisol levels were inappropriately low in several infants already before dexamethasone therapy (median 190, range 60-357 nmol/l). The 95% confidence intervals of mean serum cortisol levels at 20 min were equal in LD- and SD-ACTH, while at 60 min, the low-dose gave a clearly lower response than the standard-dose test. The LD-ACTH can be used in premature infants as in older children and adults, but the criteria for adrenocortical insufficiency need to be defined.