Do cortisol concentrations predict short-term outcomes in extremely low birth weight infants?

Area of Science:

• Neonatalogy
• Endocrinology
• Perinatal Medicine

Background:

• Relative adrenal insufficiency is a concern in extremely low birth weight (ELBW) infants, potentially leading to poor outcomes.
• Understanding the relationship between cortisol levels and short-term outcomes in ELBW infants is crucial for clinical management.

Purpose of the Study:

• To investigate the association between cortisol concentrations and short-term morbidity and mortality in intubated ELBW infants.
• To determine if cortisol levels can predict adverse outcomes in this vulnerable population.

Main Methods:

• A multicenter, randomized trial involving 350 intubated ELBW infants.
• Cortisol levels were measured at 12-48 hours and 5-7 days postnatally.
• Outcomes were prospectively monitored, and cortisol levels were analyzed by quartiles and extreme percentiles (<10th, >90th).

Main Results:

• Low cortisol concentrations (<10th percentile) at either time point were not associated with increased morbidity or mortality.
• High cortisol concentrations (>90th percentile) at baseline were significantly linked to higher rates of death, severe intraventricular hemorrhage, and other morbidities.
• Vasopressor use was lower in infants with lower baseline cortisol levels.

Conclusions:

• Low cortisol levels alone do not identify ELBW infants at highest risk for adverse outcomes.
• High cortisol concentrations, particularly extremely elevated values, are associated with increased rates of severe intraventricular hemorrhage, morbidity, and mortality in ELBW infants.
• Cortisol levels may serve as a marker for severe complications rather than a predictor of general adverse outcomes in ELBW infants.