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Prevalence of Low Cortisol Values in Term and Near-Term Infants with Vasopressor-Resistant Hypotension

Journal of Perinatology volume 25, pages 114–118 (2005)Cite this article

Abstract

OBJECTIVE:

To determine the prevalence of low cortisol values and to evaluate clinical responses to hydrocortisone in ill term and near-term newborns.

STUDY DESIGN:

Retrospective cohort study including infants ≥35 weeks gestational age who were mechanically ventilated, received vasopressor therapy, and had a cortisol concentration obtained for evaluation of vasopressor-resistant hypotension. In those infants treated with hydrocortisone, physiologic responses were evaluated and correlated with cortisol values (<15 vs ≥15 μg/dl).

RESULTS:

A total of 32 infants had cortisol values obtained; 18 (56%) were <15 μg/dl. In all, 21 infants were treated with hydrocortisone of whom 13 had cortisol values <15 μg/dl. These 13 infants showed decreased heart rate, dopamine support and fluid bolus requirements after treatment, compared to infants with values ≥15 μg/dl (n=8).

CONCLUSIONS:

A significant number of hypotensive, mechanically ventilated infants have evidence of inadequate adrenal function. Hydrocortisone therapy resulted in hemodynamic stabilization in this population.

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References

  1. Baldwin WA, Allo M . Occult hypoadrenalism in critically ill patients. Arch N Surg 1993;128:673–676.

    Article  CAS  Google Scholar 

  2. Bone M, Diver M, Selby A, Sharples A, Addison M, Clayton P . Assessment of adrenal function in the initial phase of meningococcal disease. Pediatrics 2002;110:563–569.

    Article  Google Scholar 

  3. Briegel J, Kellermann W, Forst H, et al. Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. Clin Invest 1994;72:782–787.

    Article  CAS  Google Scholar 

  4. Finlay WE, McKee JI . Serum cortisol levels in severely stressed patients. Lancet 1982;1:1414–1415.

    Article  CAS  Google Scholar 

  5. Joosten KFM, De Kleijn ED, Westerterp M, et al. Endocrine and metabolic responses in children with meningococcal sepsis: striking differences between survivors and nonsurvivors. J Clin Endocrinol Metab 2000;85:3746–3753.

    Article  CAS  Google Scholar 

  6. Rothwell PM, Udwadia ZF, Lawler PG . Cortisol response to corticotropin and survival in septic shock. Lancet 1991;337:582–583.

    Article  CAS  Google Scholar 

  7. Sibbald WJ, Short A, Cohen MP, Wilson RF . Variations in adrenocortical responsiveness during severe bacterial infections: unrecognized adrenocortical insufficiency in severe bacterial infections. Ann Surg 2003;186:29–33.

    Article  Google Scholar 

  8. Soni A, Pepper GM, Wyrwinski PM, et al. Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels. Am J Med 1995;98:266–271.

    Article  CAS  Google Scholar 

  9. Lamberts SWJ, Bruining HA, De Jong FH . Corticosteroid therapy in severe illness. N Engl J Med 1997;337:1285–1292.

    Article  CAS  Google Scholar 

  10. McKee JI, Finlay WE . Cortisol replacement in severely stressed patients. Lancet 1983;1:484–485.

    Article  CAS  Google Scholar 

  11. Cooper MS, Stewart PM . Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003;348:727–734.

    Article  CAS  Google Scholar 

  12. Claussen MS, Landercasper J, Cogbill TH . Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature. J Trauma 1992;32:94–100.

    Article  CAS  Google Scholar 

  13. Kidess AI, Caplan RH, Reynertson RH, Wickus GG, Goodnough DE . Transient corticotropin deficiency in critical illness. Mayo Clin Proc 1993;68:435–441.

    Article  CAS  Google Scholar 

  14. Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862–871.

    Article  CAS  Google Scholar 

  15. Ng PC, Lam CWK, Fok TF, et al. Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed 2001;84:F122–4.

    Article  CAS  Google Scholar 

  16. Scott SM, Watterberg KL . Effect of gestational age, postnatal age, and illness on plasma cortisol concentrations in premature infants. Pediatr Res 1995;37:112–116.

    Article  CAS  Google Scholar 

  17. Helbock HJ, Insoft RM, Conte FA . Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics 1993;92:715–717.

    CAS  PubMed  Google Scholar 

  18. Fauser A, Pohlandt F, Bartmann P, Gortner L . Rapid increase of blood pressure in extremely low birth weight infants after a single dose of dexamethasone. Eur J Pediatr 1993;152:354–356.

    Article  CAS  Google Scholar 

  19. Gaissmaier RE, Pohlandt F . Single-dose dexamethasone treatment of hypotension in preterm infants. J Pediatr 1999;134:701–705.

    Article  CAS  Google Scholar 

  20. Seri I, Tan R, Evans J . Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001;107:1070–1074.

    Article  CAS  Google Scholar 

  21. Tantivit P, Subramanian N, Garg M, Ramanathan R, deLemos RA . Low serum cortisol in term newborns with refractory hypotension. J Perinatol 1999;19:352–357.

    Article  CAS  Google Scholar 

  22. Davidian M . Applied Longitudinal Data Analysis, Class Syllabus (ST-732). Raleigh, NC: North Carolina State University, Spring 2002. (www.stat.ncsu.edu/~st732_info/Davidian/#syllabus).

  23. Gunn VL, Nechyba C . The Harriet Lane Handbook. Missouri: Harcourt; 2002. p. 712, 907.

  24. Hanna CE, Jett PL, Laird MR, Mandel SH, LaFranchi SH, Reynolds JW . Corticosteroid binding globulin, total serum cortisol, and stress in extremely low-birth-weight infants. Am J Perinat 1997;14:201–204.

    Article  CAS  Google Scholar 

  25. Williams GH, Dluhy RG . Disorders of the adrenal cortex. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2001. p. 2001–2084.

  26. LE Roux CW, Chapman GA, Kong WM, Dhillo WS, Jones J, Alaghband-Zadeh J . Free cortisol index is better than serum total cortisol in determining hypothalamic–pituitary-adrenal status in patients undergoing surgery. J Clin Endocrinol Metab 2003;88:2045–2048.

    Article  CAS  Google Scholar 

  27. Pittinger TP, Sawin RS . Adrenocortical insufficiency in infants with congenital diaphragmatic hernia: a pilot study. J Pediatr Surg 2000;35:223–226.

    Article  CAS  Google Scholar 

  28. Thomas S, Murphy JF, Dyas J, Ryalls M, Hughes IA . Response to ACTH in the newborn. Arch Dis Child 1986;61:57–60.

    Article  CAS  Google Scholar 

  29. Soliman AT, Taman KH, Rizk MM, Nasr IS, AIRimawy H, Hamido MSM . Circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations in normal, appropriate-for-gestational-age newborns versus those with sepsis and respiratory distress: cortisol response to low-dose and standard-dose ACTH tests. Metabolism 2004;53:209–214.

    Article  CAS  Google Scholar 

  30. Winter JSD . Fetal and Neonatal Adrenocortical Physiology. In: Polin RA, Fox WW, Abman SH, editors. Fetal and Neonatal Physiology. Philadelphia, PA: WB Saunders; 2004. p. 1915–1925.

    Chapter  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics/Neonatology, The University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Erika Fernandez MD & Kristi Watterberg MD

  2. Department of Mathematics and Statistics, The University of New Mexico, Albuquerque, NM, USA

    Ron Schrader PhD

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  1. Erika Fernandez MD
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  2. Ron Schrader PhD
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  3. Kristi Watterberg MD
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Fernandez, E., Schrader, R. & Watterberg, K. Prevalence of Low Cortisol Values in Term and Near-Term Infants with Vasopressor-Resistant Hypotension. J Perinatol 25, 114–118 (2005). https://doi.org/10.1038/sj.jp.7211211

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