title: Neonatal hydrocortisone therapy does not have a serious suppressive effect on the later function of the hypothalamus-pituitary-adrenal axis.
abstract: OBJECTIVE
  This study investigated whether providing extremely low birthweight (ELBW) infants with a large amount of hydrocortisone had a serious suppressive effect on the later function of the hypothalamus-pituitary-adrenal (HPA) axis.
  
  
  METHODS
  We evaluated the function of the HPA axis in 58 ELBW infants receiving 9.0 ± 7.2 mg/kg of intravenous and 68.1 ± 34.1 mg/kg of oral hydrocortisone using a human corticotropin-releasing hormone stimulation test. The mean age at investigation was 12.0 ± 5.2 months. The response was judged to be normal when the maximum to minimum ratio of the plasma adrenocorticotropic hormone (ACTH) concentration was >2, the peak value of the serum cortisol concentration was >552 nmol/L, or the increment was >193 nmol/L than baseline concentration.
  
  
  RESULTS
  Of the 58 infants studied, 51 (88%) displayed a normal response to both the ACTH and cortisol secretion and seven infants (12%) who were judged to be poor responders exhibited a peak cortisol value of >386 nmol/L without any episode of adrenal insufficiency.
  
  
  CONCLUSIONS
  Providing ELBW infants with a daily low dose of long-term hydrocortisone therapy should not lead to a serious suppressive effect on the later function of the HPA axis, regardless of the administration method.
authors.affiliation: Department of Pediatrics, National Hospital Organization, Saga National Hospital, Saga, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Takayanagi
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.forename: Tomoko
authors.initials: T
authors.lastname: Egashira
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mizukami
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D003346:Corticotropin-Releasing Hormone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects* / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects*
chemical_list: D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Cortisol; Extremely low birthweight infants; Hydrocortisone therapy; Hypothalmus-pituitary-adrenal axis; Neonatal intensive care unit