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Association of plasma cortisol and chronic lung disease in preterm infants

B A Banks1, N Stouffer, A Cnaan

  • 1Department of Pediatrics, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4318, USA.

Pediatrics
|March 7, 2001
PubMed

Insights

In preterm infants, cortisol levels in the first week are a weak predictor of chronic lung disease (CLD). Further research is needed to determine the risks and benefits of supplemental cortisol for high-risk newborns.

Area of Science:

  • Neonatal Medicine
  • Endocrinology
  • Pulmonology

Background:

  • Preterm infants may exhibit developmental immaturity of the hypothalamic-pituitary-adrenal axis.
  • Reduced cortisol response to stress in preterm infants is linked to an increased risk of chronic lung disease (CLD).

Purpose of the Study:

  • To investigate the relationship between endogenous corticosteroid levels and the risk of developing CLD in preterm infants.
  • To assess if antenatal corticosteroid treatment influences neonatal cortisol levels.

Main Methods:

  • Plasma cortisol levels were measured in 314 preterm infants (24-32 weeks' gestation) during the first 28 days of life.
  • Infants were part of the North American Thyrotropin-Releasing Hormone (TRH) Collaborative Trial, receiving antenatal corticosteroids and TRH or placebo.
  • Logistic regression models adjusted for gestational age and the Clinical Risk Index for Babies (CRIB) score were used to analyze the association between cortisol and CLD at 36 weeks' postmenstrual age (CLD36).

Main Results:

  • Mean cortisol levels varied from 3.1 microg/dL at birth to a peak of 19.4 microg/dL at 24 hours, decreasing to 5.9 microg/dL by 14-28 days.
  • Cortisol levels in the first week were not associated with gestational age but showed a positive correlation with the CRIB score.
  • A statistically borderline negative association was observed between median cortisol levels (3-7 days) and CLD36, with minimal influence on predicted CLD36 probability after adjustments.

Conclusions:

  • Basal plasma cortisol concentration in the first week of life is a weak predictor of CLD36 in preterm infants.
  • The potential benefits and risks associated with supplemental low-dose cortisol treatment for high-risk preterm infants require further investigation.
Abstract

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