Neonatal catecholamine levels and neurodevelopmental outcome: a cohort study.
OBJECTIVE
To determine whether neonatal plasma catecholamine concentrations can be used to predict (a) death plus disability and (b) motor and cognitive impairment at 5 years of age.


METHODS
A cohort comprised 136 preterm infants from two randomised controlled trials of neonatal sedation (1989-1992). Adrenaline (epinephrine) and noradrenaline (norepinephrine) were measured at baseline (first day) and 24 hours later. Intelligence and motor ability were assessed at 5-6 years.


RESULTS
Infants who died or sustained disability had significantly higher plasma noradrenaline levels on the second day of life. Noradrenaline levels above 9.0 nmol/l were most predictive of death (likelihood ratio 3.27; 95% confidence interval 1.48 to 7.23) and death plus disability (likelihood ratio 3. 55; 95% confidence interval 1.77 to 7.10). There was no correlation between neonatal catecholamine levels and cognitive or motor impairment at 5-6 years.


CONCLUSIONS
Elevated noradrenaline levels are associated with adverse outcome in preterm infants; however, the power to predict death or disability is limited and they are not predictive of later motor or cognitive impairment.
Evans
D J
DJ
Centre for Reproduction, Growth and Development, University of Leeds, D Floor Clarendon Wing, General Infirmary at Leeds, Leeds LS2 9NS, UK. evans_d@southmead.swest.nhs.uk
MacGregor
R J
RJ
Dean
H G
HG
Levene
M I
MI
D015415:Biomarkers / Q000097:blood; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D002658:Developmental Disabilities / Q000097:blood*; D004837:Epinephrine / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007361:Intelligence Tests; D009638:Norepinephrine / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D018709:Statistics, Nonparametric; D017741:Survivors
D015415:Biomarkers; D009638:Norepinephrine; D004837:Epinephrine