title: Persistent high activity of the fetal adrenal cortex in preterm infants: is there a clinical significance?
abstract: BACKGROUND
  In preterm infants, the activity of the fetal adrenal cortex continues until term. Dehydroepiandrosterone sulphate can block the synthesis of surfactant in vitro. The incidence of pulmonary disease is higher in male than in female preterm infants.
  
  
  OBJECTIVE
  To investigate the relationship between urinary excretion of fetal zone steroids (3beta-OH-5-ene-steroids) and the severity of lung disease in preterm infants with respect to gender.
  
  
  METHODS
  3beta-OH-5-ene-steroids were profiled by gas chromatography-mass spectrometry in 24-h urinary samples in 61 preterm infants of less than 30 weeks gestational age.
  
  
  RESULTS
  The incidence of respiratory distress syndrome treated with surfactant in females (n = 30) was 47% and in males (n = 31) 71%, p = 0.07. Medians of total excretion rates of fetal zone steroids (microg/kg/d) in female (male) preterm infants were at day 1: 1,317 (895); day 2: 3,154 (7,723), p = 0.03; day 3: 5,502 (9,494), p = 0.08; day 5: 7,140 (10,407); week 2: 8,731 (9,720); week 3: 8,571 (10,079); week 4: 7,620 (7,825). Regression analysis did not reveal a significant influence of maximum excretion rates of fetal zone steroids or gender on the incidence of respiratory distress syndrome treated with surfactant.
  
  
  CONCLUSIONS
  Excretion rates of fetal zone steroids were 4-fold higher than previously reported indicating a persistent high activity of the fetal adrenal zone in preterm infants. Excretion rates of fetal zone steroids were significantly higher in male preterm infants compared to females at day 2 (trend at day 3) but did not have a significant influence on the incidence of respiratory distress syndrome.
authors.affiliation: Department of General Pediatrics and Neonatology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany. Matthias.Heckmann@paediat.med.uni-giessen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Heckmann
authors.forename: Michaela F
authors.initials: MF
authors.lastname: Hartmann
authors.forename: Birgit
authors.initials: B
authors.lastname: Kampschulte
authors.forename: Heike
authors.initials: H
authors.lastname: Gack
authors.forename: Rolf-Hasso
authors.initials: RH
authors.lastname: Bödeker
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Wudy
mesh_terms: D000302:Adrenal Cortex / Q000196:embryology* / Q000378:metabolism*; D019314:Dehydroepiandrosterone Sulfate / Q000652:urine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D008297:Male; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012044:Regression Analysis; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D012720:Severity of Illness Index; D012727:Sex Characteristics; D013256:Steroids / Q000652:urine
chemical_list: D011663:Pulmonary Surfactants; D013256:Steroids; D019314:Dehydroepiandrosterone Sulfate