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Published on: June 29, 2013
Fetal growth and the function of the adrenal cortex in preterm infants
R J Bolt1, M M van Weissenbruch, C Popp-Snijders
1Research Institute of Endocrinology, Reproduction, and Metabolism, Department of Pediatrics, VU University Medical Center, NL-1007 MB Amsterdam, The Netherlands. roel.bolt@vumc.nl
Insights
Preterm infants small for gestational age show a reduced adrenal response to ACTH stimulation, linked to fetal growth. This diminished adrenal function may contribute to higher neonatal morbidity in these infants.
Area of Science:
- Neonatology
- Endocrinology
- Pediatric Research
Background:
- Preterm infants who are small for gestational age (SGA) face increased neonatal morbidity compared to appropriate for gestational age (AGA) infants.
- A potential contributing factor to this higher morbidity is a diminished adrenal response to stress.
Purpose of the Study:
- To investigate the relationship between fetal growth and the adrenal cortex response to adrenocorticotropic hormone (ACTH) stimulation in preterm infants.
- To analyze cortisol and 17-hydroxyprogesterone (17-OHP) responses in relation to birth weight standard deviation scores (BW-SDS).
Main Methods:
- ACTH stimulation tests were performed on 43 preterm infants (born ≤ 32 weeks gestation).
- Cortisol and 17-OHP levels post-ACTH stimulation were analyzed against BW-SDS, adjusted for gestational age, gender, and parity.
- Basal cortisone levels and cortisol/cortisone ratios were also assessed.
Main Results:
- Birth weight standard deviation score (BW-SDS) was significantly associated with cortisol and 17-OHP responses to ACTH stimulation.
- Infants with the lowest BW-SDS exhibited the lowest cortisol levels post-stimulation.
- No significant effect of birth size was observed on the cortisol/17-OHP ratio, suggesting unaffected 21- and 11β-hydroxylase activities.
Conclusions:
- The adrenal response to ACTH stimulation in preterm infants is directly related to fetal growth.
- Lower adrenal responsiveness in growth-restricted preterm infants may play a role in neonatal morbidity and potentially later-life diseases.
Abstract:
Small for gestational age preterm infants have a higher risk of neonatal morbidity compared to appropriate for gestational age preterm infants. A diminished adrenal response to stress may be involved in the higher postnatal morbidity. The adrenal cortex response in relation to fetal growth was studied by ACTH stimulation tests in 43 preterm infants (born < or = 32 wk). The cortisol and 17-hydroxyprogesterone (17-OHP) responses to 1 microg/kg ACTH were analyzed in relation to birth weight SD scores (BW-SDS) corrected for gestational age, gender, and parity. BW-SDS was significantly associated with the cortisol and 17-OHP response. Infants with the lowest BW-SDS had the lowest cortisol levels after stimulation. No effect of size at birth was found on the ratio between cortisol and 17-OHP. In addition, basal cortisone levels in a single blood sample were higher in infants with the lowest BW-SDS than in infants with higher BW-SDS, but the ratio between cortisol and cortisone was comparable in the two groups. We conclude that the response of cortisol and 17-OHP to ACTH stimulation in preterm infants is related to fetal growth. The lack of influence of fetal growth on the ratio between cortisol and 17-OHP after ACTH stimulation suggests that the activities of 21- and 11 beta-hydroxylase are not affected. The lower adrenal response to stimulation may be important in neonatal morbidity and possibly the development of disease in later life in growth-restricted preterm infants.
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