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Refractory hypotension in preterm infants with adrenocortical insufficiency
1Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong. pakcheungng@cuhk.edu.hk
Archives of Disease in Childhood. Fetal and Neonatal Edition
|February 24, 2001
Summary
Severe hypotension in preterm infants resistant to standard treatment may indicate adrenal insufficiency. Prompt corticosteroid therapy can be life-saving, addressing endocrine dysfunction at the adrenal level.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Critical Care
Background:
- Preterm, very low birthweight infants often experience severe hypotension.
- Hypotension in neonates can be resistant to conventional treatments like volume expansion and inotropes.
Purpose of the Study:
- To describe cases of severe hypotension in preterm infants with adrenocortical insufficiency.
- To highlight the efficacy of corticosteroid treatment in such cases.
Main Methods:
- Case series of five preterm infants with severe hypotension.
- Evaluation of response to volume expansion, inotropes, and corticosteroids.
- Human corticotrophin releasing hormone (hCRH) testing to assess pituitary response.
Main Results:
- Profound hypotension was resistant to volume expansion and inotropes.
- Corticosteroid treatment led to a prompt and positive response.
- hCRH testing confirmed adequate pituitary function, indicating adrenal-level endocrine dysfunction.
Conclusions:
- Adrenocortical insufficiency should be considered in severely hypotensive preterm infants unresponsive to conventional therapy.
- Corticosteroid treatment is a potentially life-saving intervention for this condition.