Abstract
Background/aims: To determine whether the 17-hydroxyprogesterone (17-OHP)/cortisol ratio as a marker of immature11-beta hydroxylase activity can predict severe systemic hypotension in preterm neonates. Methods: Serum cortisol and 17-OHP concentrations were measured in capillary blood deposited on blotter paper on day 3 post-natal age (Day 3) in infants less than 32 weeks postmenstrual age (PMA). The predictive value of 17-OHP/cortisol ratio for a first episode of systemic hypotension occurring after Day 3 (FESH) was evaluated. Results: Of 105 infants included, 14 patients (13%) presented a FESH. Neither the 17-OHP/cortisol ratio, nor the 17-OHP or cortisol concentrations were associated with the occurrence of a FESH when adjusted for potential confounding factors. 17-OHP and cortisol were inversely associated to PMA (r = ﹣0.36 and ﹣0.40, respectively). Cortisol, but not 17-OHP, was associated with the type of hospitalization unit, the respiratory support and the presence of a patent ductus arteriosus. The 17-OHP/cortisol ratio was associated with the type of hospitalization unit only. Conclusions: The 17-OHP/ cortisol ratio at Day 3 did not predict the occurrence of a first episode of systemic hypotension after Day3 inpreterm neonates.
Highlights
Adequate adrenal function is a major issue for patients with acute life-threatening diseases
Neither the 17-OHP/cortisol ratio, nor the 17-OHP or cortisol concentrations were associated with the occurrence of a first episode of systemic hypotension (FESH) when adjusted for potential confounding factors. 17-OHP and cortisol were inversely associated to postmenstrual age (PMA) (r = −0.36 and −0.40, respectively)
All infants born prior to 32 weeks postmenstrual age (PMA) between September 2006 and September 2007 and admitted in the neonatal intensive care unit (ICU) or the neonatology unit at the tertiary-care University Children’s Hospital of Bordeaux (France) were eligible if they did not present one of the following exclusion criteria: death within the first 4 days of life, glucocorticoid administration preceding blood sampling on the 3rd day of life, congenital diseases of the heart/brain/lung/liver/ kidney diagnosed after birth and adrenal disorders diagnosed after birth
Summary
Adequate adrenal function is a major issue for patients with acute life-threatening diseases. Elevated cortisol levels in critically-ill patients, reflecting activation of the pituitary-adrenal axis, are considered to be a homeostatic adaptation. In prolonged critical illnesses such as multiorgan failure, a state of relative or functional adrenal insufficiency characterized by an inadequate production of cortisol despite an increased demand could lead to refractory hypotension and to hydrocortisone treatment [1]. Severe hypotension refractory to both volume expansion and inotropic agents have been related to relative adrenal insufficiency [2]. These patients respond readily to hydrocortisone, suggesting that an inadequate hypothalamic-pituitary-adrenal (HPA) response to stress may be a major cause [2,3,4]. Effective treatments are essential because severe and prolonged hypotension is associated with increased mortality and central nervous system morbidity [5,6]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call