Cortisol precursors in neonates with vasopressor-resistant hypotension in relationship to demographic characteristics

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p><em>Objective:</em>To correlate between cortisol precursors in neonates with vasopressor resistant hypotension and demographic characteristics.</p><p><em>Methods:</em>We investigated 48 neonates with vasopressor-resistant hypotension. Gestation at birth ranged from 34 to 42 weeks and postnatal age from 4 to 14 days. Cortisol and precursor steroids were measured soon after the onset of volume expansion and inotropes for treatment of shock. Their concentrations were determined using liquid chromatography/mass spectrometry.</p><p><em>Results:</em>In neonates with vasopressor-resistant hypotension, the serum levels of cortisol were within normal nonstress range. There was a strong negative linear association between postnatal age and dehydroepiandrosterone level (<em>r</em> = −0.50, <em>p</em> < .01), which decreased with neonatal age. In addition, there was a significant positive association between gestational age at birth and 17-hydroxy-pregnenolone (<em>r</em> = 0.33, p = .02). No further significant associations were evident between the neonatal weight, duration of gestation or gender and of the levels of cortisol or the other steroids (<em>p</em> > .05). The cause of therapy-resistant hypotension did not appear to influence the steroid levels.</p><p><em>Conclusions:</em>Cortisol stress response is absent in these severely ill late preterm and term infants. This may be due to inhibition of the distal pathway of cortisol synthesis.</p></div>