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Adrenal function in preterm infants undergoing patent ductus arteriosus ligation
Afif EL-Khuffash1, Patrick J McNamara, Anie Lapointe
1Department of Paediatrics, Rotunda Hospital, Dublin, Ireland.
Neonatology
|May 3, 2013
Summary
Adrenal insufficiency may contribute to cardiorespiratory instability after patent ductus arteriosus (PDA) ligation in preterm infants. Post-ACTH cortisol levels below 750 nmol/l were linked to hypotension and ventilation failure, suggesting a role for relative adrenal insufficiency.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Endocrinology
Background:
- Targeted milrinone therapy for low left ventricular output (LVO) after patent ductus arteriosus (PDA) ligation in preterm infants aims to reduce cardiorespiratory instability.
- Despite treatment, some infants experience postoperative deterioration, prompting investigation into potential underlying mechanisms like adrenal insufficiency.
- Prematurity-related adrenal insufficiency has been postulated as a contributing factor to postoperative complications in these vulnerable infants.
Purpose of the Study:
- To assess adrenal function in premature infants undergoing PDA ligation.
- To investigate the association between adrenal function (cortisol levels) and clinical/echocardiographic indicators of disease severity before and after surgery.
- To explore the predictive value of adrenal response to adrenocorticotropic hormone (ACTH) stimulation for postoperative outcomes.
Main Methods:
- A retrospective cohort study included 35 preterm infants who underwent PDA ligation and received preoperative ACTH stimulation testing.
- Infants were assessed for LVO via echocardiography 1 hour post-surgery, with milrinone administered if LVO <200 ml/kg/min.
- Primary outcome was LVO; secondary outcomes included hypotension, and oxygenation/ventilation failure within 24 hours.
Main Results:
- No significant association was found between preoperative or post-ACTH cortisol levels and postoperative low LVO.
- However, post-ACTH cortisol levels ≤750 nmol/l were significantly associated with increased risk of hypotension (p=0.03) and oxygenation/ventilation failure (p=0.04, p=0.008).
- Receiver-operator characteristic analysis indicated a high predictive value of post-ACTH cortisol for clinical outcomes.
Conclusions:
- Post-ACTH cortisol levels ≤750 nmol/l may indicate a higher risk of cardiorespiratory instability following PDA ligation.
- Relative adrenal insufficiency could be a significant factor in the hemodynamic and respiratory complications observed after PDA ligation in preterm infants.
- Adrenal function assessment may aid in identifying infants at risk for postoperative instability.
