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Adrenocortical function and chronic lung disease of pre-maturity: an unresolved problem?
C Romagnoli1, C Latella, E Zecca
1Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy. cromagnoli@rm.unicatt.it
Insights
Adrenocortical function, measured by plasma cortisol (F) and ACTH, was studied in preterm infants. Higher levels were observed in infants who developed chronic lung disease (CLD) at 14 and 21 days, but this did not predict CLD development.
Area of Science:
- Neonatology
- Endocrinology
- Pediatric Pulmonology
Background:
- Preterm infants are susceptible to chronic lung disease (CLD).
- Adrenocortical function plays a role in infant development and stress response.
- The relationship between adrenocortical hormones and CLD in preterm infants requires further investigation.
Purpose of the Study:
- To investigate the association between adrenocortical function and the development of CLD in preterm infants.
- To determine if plasma cortisol (F) and ACTH levels can predict CLD in this population.
Main Methods:
- Plasma F and ACTH levels were measured in 25 preterm infants (<32 weeks gestation, <1250g birth weight) at 7, 14, 21, and 28 days of life.
- Infants were categorized into CLD and no CLD (NOCLD) groups.
- ACTH stimulation tests were performed on days 7 and 28.
Main Results:
- Plasma F and ACTH levels were similar between groups at day 7.
- The CLD group showed significantly higher plasma F and ACTH concentrations at days 14 and 21 compared to the NOCLD group (p<0.05).
- No significant differences were found at day 28, and ACTH stimulation responses were similar between groups.
Conclusions:
- There is no significant association between adrenal insufficiency and CLD in preterm infants.
- Baseline or stimulated plasma F levels are not reliable predictors for the development of CLD in preterm infants.
- Further research may explore other factors influencing CLD development in this vulnerable population.
Abstract:
The aim of this study was to investigate the relationship between adrenocortical function and chronic lung disease (CLD) of pre-term infants. Plasma F and ACTH were measured at 7, 14, 21 and 28 days of life in 25 pre-term infants with gestational age < or = 32 weeks and birth weight < or = 1,250 g. Fourteen infants developed CLD (CLD group) and 11 recovered without CLD (NOCLD group). Response to ACTH stimulation was tested on days 7 and 28. The results show that at the 7th day of life plasma F and ACTH levels were similar in the NOCLD and CLD group. CLD group had significantly higher plasma F and ACTH concentrations at the 14th (p=0.006 for F and p=0.020 for ACTH) and at the 21st (p=0.008 for F and p=0.024 for ACTH) day of life, while no significant differences were detected at the 28th day of life. The response to ACTH stimulation test was similar between the NOCLD and CLD group. These data demonstrate the lack of any significant association between adrenal insufficiency and CLD and discourage the use of baseline or stimulated plasma F levels to predict the development of CLD in pre-term infants.