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Serum cortisol concentrations in ill preterm infants less than 30 weeks gestational age
M Heckmann1, S A Wudy, D Haack
1Department of Pediatrics, University of Ulm, Germany. Matthias.Heckmann@paediat.med.uni-giessen.de
Insights
Serum cortisol levels in ill preterm infants treated with catecholamines varied, with some showing significantly lower concentrations than well infants. This suggests potential adrenal insufficiency in critically ill neonates.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatric Critical Care
Background:
- Adrenal insufficiency is a concern in sick preterm infants.
- Arterial hypotension in neonates can indicate adrenal insufficiency.
- Catecholamine treatment is used for hypotension in preterm infants.
Purpose of the Study:
- To compare serum cortisol concentrations in well preterm infants versus ill preterm infants.
- To investigate cortisol levels in ill preterm infants treated with catecholamines compared to those not treated.
- To assess the relationship between illness severity, hypotension treatment, and cortisol levels in preterm neonates.
Main Methods:
- Prospective study comparing serum cortisol in three groups of preterm infants (<30 wk gestational age) during the first two weeks of life.
- Group A: Well preterm infants.
- Group B: Ill preterm infants treated with catecholamines for hypotension.
- Group C: Ill preterm infants not treated with catecholamines.
- Cortisol levels analyzed, with subgroups formed based on illness severity and treatment response.
Main Results:
- No significant difference in cortisol levels between well infants (Group A) and ill infants not treated with catecholamines (Group C).
- Ill infants treated with catecholamines (Group B) showed a double-peaked cortisol distribution.
- A subgroup of catecholamine-treated infants (B1) had significantly lower cortisol concentrations than well infants (Group A) (p=0.00097).
- Illness severity differed significantly across groups (A < C < B), correlating with treatment and cortisol levels.
Conclusions:
- Catecholamine treatment for hypotension in preterm infants may be associated with altered serum cortisol patterns.
- Lower cortisol levels in a subgroup of treated infants suggest potential adrenal insufficiency requiring further investigation.
- Illness severity is a critical factor influencing cortisol concentrations and treatment response in preterm neonates.
Abstract:
Adrenal insufficiency is suspected in some ill preterm infants. The aim of this prospective study was to compare serum cortisol concentrations during the first 2 wk of life of well preterm infants (group A) less than 30 wk of gestational age with the cortisol concentrations of ill preterm infants whose arterial hypotension-a potential sign of adrenal insufficiency-had been treated with catecholamine (group B), and the cortisol concentrations of ill preterm infants who had not been so treated (group C). Cortisol concentrations did not differ significantly between group A (240 nmol/l, 58-659; n = 46) (median, minimum-maximum) and group C (268 nmol/l, 58-1007; n = 25). Group B had a double-peaked distribution of cortisol. Two subgroups were formed by taking the highest cortisol level of group A as a threshold: group B1 (110 nmol/l, 41-378; n = 20) and group B2 (1200nmol/l, 764-1482; n = 8). The cortisol concentrations of group B1 were significantly lower (p = 0.00097) compared to the cortisol concentrations of the well preterm infants (group A). The severity of illness, which was quantified by two scoring systems, differed significantly among the groups (p < 0.003 for all comparisons) with the following sequence: A < C < B, but not between B1 and B2, as clinical variables were not different between the subgroups.
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