Do cortisol concentrations predict short-term outcomes in extremely low birth weight infants?

被引:49
作者
Aucott, Susan W. [1 ]
Watterberg, Kristi L. [3 ]
Shaffer, Michele L. [4 ,5 ]
Donohue, Pamela K. [1 ,2 ]
机构
[1] Johns Hopkins Univ, Dept Pediat, Sch Med, Baltimore, MD 21218 USA
[2] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD 21218 USA
[3] Univ New Mexico, Sch Med, Dept Pediat, Albuquerque, NM 87131 USA
[4] Penn State Univ, Dept Publ Hlth, Hershey, PA USA
[5] Penn State Univ, Coll Med, Dept Pediat, Hershey, PA USA
关键词
bronchopulmonary dysplasia; extremely preterm infants; hydrocortisone; outcomes of high-risk infants;
D O I
10.1542/peds.2007-2252
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
OBJECTIVE. Relative adrenal insufficiency in extremely low birth weight infants may contribute to significant morbidity and death. Our objective was to evaluate the relationship between cortisol concentrations and short-term outcomes. METHODS. Cortisol concentrations were obtained for 350 intubated, extremely low birth weight infants at postnatal age of 12 to 48 hours and at day 5 to 7, as part of a multicenter, randomized trial of hydrocortisone treatment for prophylaxis of relative adrenal insufficiency. Death and short-term morbidity were monitored prospectively. Cortisol levels at each time point were divided into quartiles. The incidence rates of outcomes were determined for each quartile and for infants with cortisol values of < 10th percentile or > 90th percentile. RESULTS. Median cortisol values were 16.0 mu g/dL at baseline and 13.1 mu g/dL on day 5 to 7 in the placebo group. Outcomes did not differ in each quartile between treatment and placebo groups. Low cortisol values at baseline or day 5 to 7 were not associated with increased morbidity or mortality rates and were not predictive of open-label hydrocortisone use. In fact, vasopressor use was lower for infants with lower cortisol values at baseline. Severe intraventricular hemorrhage was more frequent in infants with cortisol levels in the upper quartile at baseline, and values of > 90th percentile were significantly associated with higher rates of death, severe intraventricular hemorrhage, periventricular leukomalacia, gastrointestinal perforation, and severe retinopathy of prematurity. CONCLUSIONS. Low cortisol concentrations were not predictive of adverse short-term outcomes, but high cortisol concentrations were associated with severe intraventricular hemorrhage, and extremely elevated values were associated with morbidity and death. Low cortisol concentrations alone at these 2 time points did not identify the infants at highest risk for adverse outcomes. In contrast, high cortisol values were associated with increased morbidity and mortality rates.
引用
收藏
页码:775 / 781
页数:7
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