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The hypothalamic-pituitary-adrenal axis in preterm infants weighing < or = 1250 g: association with perinatal data

U Merz1, R Pfäffle, T Peschgens

  • 1Children's Hospital, Neonatal Intensive Care, Aachen University of Technology, Germany.

Acta Paediatrica (Oslo, Norway : 1992)
|April 29, 1998
PubMed

Insights

This study found no early link between adrenal function and chronic lung disease in preterm infants. However, lower cortisol levels post-dexamethasone treatment correlated with reduced ventilation needs and less chronic lung disease.

Area of Science:

  • Neonatology
  • Endocrinology
  • Pediatric Pulmonology

Background:

  • The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in stress response and development.
  • Preterm infants, especially those with low birth weight, are vulnerable to HPA axis dysfunction.
  • Chronic lung disease (CLD) is a significantcomorbidity in ventilated preterm infants.

Purpose of the Study:

  • To investigate the association between early HPA axis function and the development of CLD in very low birth weight preterm infants.
  • To identify perinatal and clinical factors differentiating infants with and without persistent HPA suppression after dexamethasone treatment for CLD.

Main Methods:

  • Evaluation of the HPA axis in 34 ventilated preterm infants (< or = 1250 g) during the first week of life.
  • Corticotropin-releasing hormone stimulation test, with measurement of cortisol and adrenocorticotropic hormone (ACTH) levels via radioimmunoassay.
  • Assessment of HPA function post-dexamethasone treatment for CLD.

Main Results:

  • No significant association was found between early cortisol and ACTH levels and the development of CLD.
  • Post-dexamethasone, 46.2% of infants had baseline cortisol levels < 138 nmol/L, with 30.8% below 83 nmol/L.
  • Infants with post-dexamethasone cortisol < 83 nmol/L exhibited significantly shorter durations of mechanical ventilation and oxygen support (p < 0.01) and a lower incidence of CLD (p < 0.05).

Conclusions:

  • Early HPA axis function in the first week of life does not predict CLD development in very low birth weight preterm infants.
  • Persistent HPA suppression after dexamethasone treatment for CLD is associated with improved respiratory outcomes, including reduced need for mechanical ventilation and supplemental oxygen.
  • Further research is warranted to understand the implications of HPA axis suppression in the context of CLD management in preterm infants.

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