Adrenal function in newborns undergoing surgery.
OBJECTIVE
To measure cortisol, adrenocorticotropic hormone (ACTH)-stimulated cortisol and ACTH values in the newborn intensive care unit-admitted newborn infants within 48 h before surgery and to describe the relationship of these values to measures of clinical illness before and after surgery.


METHODS
In this prospective observational study, we measured baseline and ACTH-stimulated cortisol concentrations within 48 h before surgery in newborn infants <44 weeks postmenstrual age and examined the relationship of these values to measures of illness severity both before and after surgery, including the score for neonatal acute physiology (SNAP) and use of vasopressors. ACTH concentrations were measured in a subset of the infants.


RESULTS
Twenty-five infants were enrolled and had median (25th to 75th percentile) baseline and ACTH-stimulated cortisol values of 7.1 (3.5 to 11.1) and 40.4 mcg per 100 ml (22.6 to 50.6). Preterm infants had significantly lower ACTH-stimulated cortisol values (median 21.6 vs 44.7 mcg per 100 ml). There was no correlation between any of these values and either the presurgical or postsurgical measures of illness severity, nor the increase in SNAP after surgery. Infants receiving vasopressors perioperatively had lower median ACTH-stimulated cortisol values (22.6 vs 44.7 mcg per 100 ml).


CONCLUSIONS
Presurgical cortisol values do not predict clinical response to surgical stress as measured by severity of illness scores but lower values were associated with vasopressor therapy. Further investigation would be required to determine how cortisol values are related to outcome and whether perioperative glucocorticoid supplementation would be beneficial in this population.
Division of Neonatology, Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131, USA. efernandez@salud.unm.edu
E F
EF
Fernandez
R
R
Montman
K L
KL
Watterberg
D000311:Adrenal Glands / Q000503:physiopathology*; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D016638:Critical Illness; D005260:Female; D005865:Gestational Age; D006305:Health Status Indicators; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D014662:Vasoconstrictor Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone