Persistent high activity of the fetal adrenal cortex in preterm infants: is there a clinical significance?
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.
Heckmann
Matthias
M
Department of General Pediatrics and Neonatology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany. Matthias.Heckmann@paediat.med.uni-giessen.de
Hartmann
Michaela F
MF
Kampschulte
Birgit
B
Gack
Heike
H
Bödeker
Rolf-Hasso
RH
Gortner
Ludwig
L
Wudy
Stefan A
SA
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
D011663:Pulmonary Surfactants; D013256:Steroids; D019314:Dehydroepiandrosterone Sulfate