Early hypoadrenalism in premature infants at risk for bronchopulmonary dysplasia or death.
OBJECTIVE
To study the relationship between serum cortisol and dehydroepiandrosterone sulphate (DHEAS) concentrations and death or bronchopulmonary dysplasia at 36 weeks of postmenstrual age in preterm infants.


METHODS
Prospective measurement of cord, day of birth (D0) and day 4 (D4) serum cortisol and DHEAS concentrations and performance of low-dose (LD) ACTH tests in 89 preterm infants with gestational age <34 weeks at birth and in need of mechanical ventilation.


RESULTS
Serum DHEAS levels correlated negatively with gestational age. At all sampling times, basal serum cortisol levels correlated positively with gestation-adjusted DHEAS levels (r = 0.39-0.46, p = 0.0032-<0.0001). The mean cord, D0 basal and stimulated cortisol, and cord and D0 DHEAS adjusted for gestational age were lower in the poor than good outcome infants (p < 0.02 for all). In the multiple logistic regression analyses, gestational age was the most significant factor affecting outcome, but low cord and D0 basal and stimulated cortisol and gestation-adjusted DHEAS levels also predicted poor outcome (OR 5.7-22; p = 0.049-0.014).


CONCLUSIONS
Low cord and first day serum cortisol and DHEAS levels associated with poor outcome in preterm infants, which suggests general relative adrenocortical insufficiency in some premature newborns.
Nykänen
Päivi
P
Department of Paediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
Anttila
Eija
E
Heinonen
Kirsti
K
Hallman
Mikko
M
Voutilainen
Raimo
R
D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D000324:Adrenocorticotropic Hormone / Q000037:antagonists & inhibitors; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005387:Finland / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000172:deficiency; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011295:Prenatal Care; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D005938:Glucocorticoids; D019314:Dehydroepiandrosterone Sulfate; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D001623:Betamethasone; D006854:Hydrocortisone