Adrenocortical Dysfunctions in Neonatal Septic Shock

The prevalence of adrenal insufficiency at the onset of neonatal septic shock was estimated. Total serum cortisol and adrenocorticotropin (ACTH) levels were measured at the onset of septic shock in term and preterm neonates. Serum cortisol levels were measured again after 30 min of 1 µg adrenocorticotropin injection. The authors defined Adrenocortical insufficiency as absolute adrenalin sufficiency (baseline serum cortisol < 15 µg/dL, rise in serum cortisol < 9 µg/dL after ACTH injection), or relative adrenal insufficiency (baseline cortisol ≥ 15 µg/dL, rise < 9 µg/dL). Thirty neonates with septic shock were enrolled. Six of them had absolute adrenal insufficiency while 2 neonates had relative adrenal insufficiency. Thus, the prevalence of adrenal insufficiency was 27% at the onset of neonatal septic shock, 95% confidence interval: 12%-46%. Seventeen (57%) neonates with septic shock had cortisol levels (< 15 µg/dL) with adequate rise (≥ 9 µg/dL) after ACTH stimulation indicating depressed baseline levels, which responded to ACTH stimulation.