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Adrenal function in sick very preterm infants.

M W Huysman1, A C Hokken-Koelega, M A De Ridder

  • 1Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital/University Hospital Rotterdam, 3000 CB Rotterdam, The Netherlands.

Pediatric Research
|October 25, 2000
PubMed
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Very preterm infants with severe illness show impaired adrenal function, indicated by lower cortisol levels. This adrenal insufficiency may impact their health outcomes, warranting further investigation into steroid supplementation.

Area of Science:

  • Neonatal Medicine
  • Endocrinology
  • Pediatric Critical Care

Background:

  • Very preterm neonates often experience circulatory and respiratory issues.
  • Steroid administration can improve symptoms in some neonates, but the cause remains unclear.
  • Adrenal insufficiency is a potential, yet unconfirmed, cause of these symptoms.

Purpose of the Study:

  • To investigate cortisol levels and adrenal response to ACTH in very preterm infants.
  • To compare adrenal function between sick (ventilated) and less sick (non-ventilated) infants.
  • To determine the relationship between adrenal function and infant outcomes.

Main Methods:

  • Administered a 0.5 microg ACTH test on day 4 to 21 very preterm infants (25.6-29.6 wk gestation).
  • Measured baseline and post-ACTH cortisol and 17-hydroxyprogesterone (17OHP) levels at 30, 60, and 120 minutes.

Related Experiment Videos

  • Assessed illness severity using the Score for Neonatal Acute Physiology.

    • Main Results:

    • All infants demonstrated increased cortisol post-ACTH, but levels were lower in ventilated, sicker infants.
    • Ventilated infants had lower baseline cortisol and cortisol/17OHP ratios, and higher 17OHP levels, adjusting for confounders.
    • Adverse outcomes correlated with lower baseline cortisol/17OHP ratios and lower 60-minute cortisol levels during ACTH testing.

    Conclusions:

    • Sick, ventilated very preterm infants (<30 wk gestation) exhibit insufficient adrenal response to stress.
    • This suggests a potential link between adrenal function and clinical outcomes in this vulnerable population.
    • Further research is needed to explore hydrocortisone supplementation benefits for these infants.