[Association between serum cortisol levels and multiple organ dysfunction in neonates with perinatal asphyxia]

Area of Science:

• Neonatalogy
• Pediatric Endocrinology
• Critical Care Medicine

Background:

• Therapy-resistant hypotension affects 16% of neonates with perinatal asphyxia undergoing therapeutic hypothermia.
• Relative adrenal insufficiency, indicated by inadequate cortisol response, is a potential cause.
• Optimal hydrocortisone dosing during hypothermia is unknown, and serum cortisol monitoring is complicated by multiorgan dysfunction and hypothermia's effects on drug metabolism.

Purpose of the Study:

• To evaluate serum cortisol levels in cooled neonates with perinatal asphyxia before and during hydrocortisone supplementation.
• To investigate the association between serum cortisol levels and the severity of multiorgan dysfunction.

Main Methods:

• Retrospective cohort study of 44 neonates treated with therapeutic hypothermia and hydrocortisone.
• Assessment of serum cortisol levels and parameters of multiorgan dysfunction severity.
• Analysis of 126 serum cortisol samples collected between January 2007 and December 2022.

Main Results:

• Two-thirds of baseline serum cortisol levels were below the threshold for relative adrenal insufficiency (median 4.6 µg/dl).
• Hydrocortisone supplementation significantly elevated cortisol levels (median 61.2 µg/dl), which further increased during therapy (median 77.6 µg/dl).
• Higher cortisol levels were observed in neonates with more severe multiorgan dysfunction, both before and after supplementation.

Conclusions:

• Hydrocortisone supplementation can increase low serum cortisol levels in neonates with perinatal asphyxia and suspected adrenal insufficiency.
• Elevated cortisol in severe multiorgan dysfunction may stem from increased hormone secretion and reduced drug metabolism/excretion.
• Further prospective pharmacokinetic studies are needed to optimize hydrocortisone therapy in this population.