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Neonatal hydrocortisone therapy does not have a serious suppressive effect on the later function of the

Toshimitsu Takayanagi1, Koji Matsuo, Tomoko Egashira

  • 1Department of Pediatrics, National Hospital Organization, Saga National Hospital, Saga, Japan.

Acta Paediatrica (Oslo, Norway : 1992)
|January 22, 2015
PubMed

Insights

Long-term hydrocortisone therapy in extremely low birthweight (ELBW) infants does not appear to suppress the hypothalamus-pituitary-adrenal (HPA) axis function. Most ELBW infants showed normal HPA axis response after treatment.

Area of Science:

  • Neonatalogy
  • Endocrinology
  • Pediatric Pharmacology

Background:

  • Extremely low birthweight (ELBW) infants often require hydrocortisone therapy.
  • Potential long-term effects of this treatment on the developing hypothalamus-pituitary-adrenal (HPA) axis are a concern.

Purpose of the Study:

  • To investigate the impact of extensive hydrocortisone administration on the HPA axis function in ELBW infants.
  • To determine if hydrocortisone therapy in ELBW infants leads to serious suppressive effects on HPA axis function.

Main Methods:

  • Evaluated HPA axis function in 58 ELBW infants using a corticotropin-releasing hormone stimulation test.
  • Assessed plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels.
  • Defined normal HPA axis response based on specific ACTH and cortisol concentration ratios and increments.

Main Results:

  • 88% of ELBW infants (51 out of 58) demonstrated a normal HPA axis response.
  • Only 12% of infants were classified as poor responders, with no instances of adrenal insufficiency.
  • Peak cortisol values in poor responders were elevated, not indicative of suppression.

Conclusions:

  • Long-term, low-dose hydrocortisone therapy in ELBW infants is unlikely to cause significant HPA axis suppression.
  • The route of administration (intravenous or oral) did not appear to influence HPA axis function.
  • Findings suggest that hydrocortisone treatment is generally safe for HPA axis development in ELBW infants.
Abstract

Keywords:
CortisolExtremely low birthweight infantsHydrocortisone therapyHypothalmus-pituitary-adrenal axisNeonatal intensive care unit

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