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Effect of dose on response to adrenocorticotropin in extremely low birth weight infants

Kristi L Watterberg1, Michele L Shaffer, Jeffery S Garland

  • 1Department of Neonatology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131-0001, USA. kwatterberg@salud.unm.edu

The Journal of Clinical Endocrinology and Metabolism
|September 15, 2005
PubMed

Insights

A higher dose of cosyntropin (1.0 microg/kg) better differentiates adrenal function in premature infants compared to a lower dose (0.1 microg/kg). This 1.0 microg/kg dose is recommended for testing adrenal function in extremely low birth weight infants.

Area of Science:

  • Neonatal endocrinology
  • Pediatric critical care

Background:

  • Adrenal function testing in premature infants lacks standardized cosyntropin dosage and response criteria.
  • Establishing appropriate testing protocols is crucial for managing critically ill neonates.

Purpose of the Study:

  • To evaluate the cortisol response in extremely low birth weight infants using two different cosyntropin doses (1.0 and 0.1 microg/kg).
  • To determine if these doses can differentiate clinical subgroups previously associated with varying responses.

Main Methods:

  • Prospective, nested study within a randomized clinical trial involving 276 infants (500-999 g birth weight).
  • Cosyntropin administered at 1.0 or 0.1 microg/kg between 18-28 days of life.
  • Cortisol levels measured to assess adrenal response.

Main Results:

  • The 1.0 microg/kg cosyntropin dose produced significantly higher cortisol levels and fewer negative responses compared to the 0.1 microg/kg dose.
  • The higher dose differentiated responses based on sex, enteral nutrition, chorioamnionitis exposure, and mechanical ventilation, and correlated with fetal growth.
  • Lower responses to the 1.0 microg/kg dose were associated with bronchopulmonary dysplasia and prolonged hospital stay.

Conclusions:

  • The 0.1 microg/kg cosyntropin dose is insufficient for differentiating adrenal response in clinical subgroups of premature infants.
  • A cosyntropin dose of 1.0 microg/kg is recommended for accurate adrenal function testing in extremely low birth weight infants.
Abstract

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