Association between plasma cortisol and death or vasopressor refractory hypotension in preterm neonates: a prospective, cohort study.

Abstract

OBJECTIVES:

Temporal relation between adrenal insufficiency and hypotension is poorly understood. We examined the association between basal and post-stimulation cortisol and death or vasopressor refractory hypotension in preterm neonates.

STUDY DESIGN:

Prospective cohort study in ≤30 weeks' and/or <1,250 g weight. Primary outcome-composite of death or vasopressor refractory hypotension by day 14 of life. Plasma cortisol levels were measured at 24-36 h (T1), 72-84 h (T2) and 10 days (T3), and post-stimulation cortisol at T1 and later at T2 and T3 if the adrenal response was inadequate earlier.

RESULTS:

Basal cortisol (µg/dl) at 24-36 h was significantly higher in the outcome group (37.2 ± 21.1 vs. 22.04 ± 14.6; mean difference (MD) (95% confidence interval (CI)): -15.1 (-23.6, -6.6); p = 0.005). High basal cortisol at 24-36 h (odds ratio (OR) (95% CI): 1.044 (1.009, 1.079); p = 0.01) and need for ventilation (OR (95% CI): 9.7 (1.2, 81.2); p = 0.04) independently increased the risk of death or vasopressor refractory hypotension.

CONCLUSION:

Preterm neonates who died or developed vasopressor refractory hypotension by day 14 had significantly elevated basal cortisol at 24-36 h of life.

• Authors: Monisha Rameshbabu, Venkataseshan Sundaram, Naresh Sachdeva, Rama Walia, Shiv Sajan Saini, Sourabh Dutta
• Journal: Journal of perinatology : official journal of the California Perinatal Association (J Perinatol) Vol. 38 Issue 6 Pg. 672-680 (06 2018) ISSN: 1476-5543 [Electronic] United States
• PMID: 29426854 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Vasoconstrictor Agents
• Hydrocortisone

Topics

• Analysis of Variance
• Cause of Death
• Cohort Studies
• Drug Resistance
• Female
• Gestational Age
• Humans
• Hydrocortisone (blood)
• Hypotension (blood, drug therapy)
• India
• Infant, Newborn
• Infant, Premature
• Infant, Very Low Birth Weight
• Intensive Care Units, Neonatal
• Male
• Multivariate Analysis
• Predictive Value of Tests
• Pregnancy
• Prognosis
• Prospective Studies
• ROC Curve
• Risk Assessment
• Survival Analysis
• Vasoconstrictor Agents (adverse effects, therapeutic use)