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Early pituitary-adrenal response and respiratory outcomes in preterm infants
1Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT. pakcheungng@cuhk.edu.hk
Insights
Persistent high cortisol levels in preterm infants may prolong oxygen needs and indicate chronic lung disease (CLD) risk. Early pituitary-adrenal responses are not independent predictors of CLD.
Area of Science:
- Neonatalogy
- Endocrinology
- Pediatric Pulmonology
Background:
- Preterm infants, especially those with very low birth weight, are susceptible to respiratory complications.
- The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in stress response and development.
- Chronic lung disease (CLD) remains a significant morbidity in this population.
Purpose of the Study:
- To investigate the association between adrenocorticotrophin (ACTH) and cortisol levels and the duration of oxygen supplementation.
- To determine the predictive value of HPA axis hormones for the development of CLD in very low birth weight infants.
Main Methods:
- Conducted corticotrophin releasing hormone stimulation tests on 137 very low birth weight infants on days 7 and 14.
- Utilized multivariate regression and classification and regression trees analyses.
Main Results:
- Duration of oxygen supplementation was linked to lower birth weight, higher alveolar-arterial oxygen gradient, and elevated basal serum cortisol on day 14.
- Clinical Risk Index for Babies (CRIB) score and peak serum cortisol on day 14 were identified as key predictors for CLD.
Conclusions:
- Birth weight, initial respiratory severity, and sustained elevated cortisol on day 14 are risk factors for prolonged oxygen use.
- Early HPA axis function (day 7) is not an independent predictor of CLD.
- While CRIB score and day 14 cortisol predict CLD, their clinical utility is limited by the need for stimulation tests and late timing.
Objective:
To assess the influence of circulating (basal) and stimulated plasma adrenocorticotrophin (ACTH) and serum cortisol on the duration of oxygen supplementation and development of chronic lung disease (CLD) in preterm, very low birthweight infants.
Methods:
A total of 226 human corticotrophin releasing hormone stimulation tests were performed on 137 very low birthweight infants on days 7 and 14 in a tertiary neonatal centre.
Results:
Multivariate regression analysis showed that the duration of oxygen supplementation was negatively associated with birth weight, but positively associated with alveolar-arterial oxygen gradient (A-aDO(2)) on the first day and with basal serum cortisol on day 14. In addition, the multivariate classification and regression trees model indicated that the two most useful indices for predicting CLD were clinical risk index for babies (CRIB) score (> 9) and peak serum cortisol (> 740 nmol/l) on day 14. The sensitivity, specificity, positive and negative predictive values of these factors for predicting CLD were 53%, 80%, 81%, and 70% respectively.
Conclusions:
The findings suggest that birth weight, severity of initial respiratory failure as reflected by the A-aDO(2) gradient, and continuing "stress" with persistent increase in serum cortisol on day 14 are significant risk factors associated with the duration of oxygen supplementation, whereas early pituitary-adrenal response (basal and peak plasma ACTH and serum cortisol on day 7) is not an independent risk factor. Although CRIB score in combination with peak serum cortisol on day 14 are useful predictors of CLD, the need to use a stimulation test and the relatively late timing of the forecast render these indices unattractive for routine clinical use.
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