Early cortisol values and long-term outcomes in extremely low birth weight infants
Early cortisol values and long-term outcomes in extremely low birth weight infants
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DOI：
10.1038/jp.2009.191
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发表时间：
2010-07-01
影响因子：
2.9
通讯作者：
Donohue, P. K.
中科院分区：
文献类型：
--
作者：
Aucott, S. W.;Watterberg, K. L.;Donohue, P. K.
目的：极低出生体重儿（ELBW）糖皮质激素水平过高和不足均与不良住院结局相关，而糖皮质激素过量暴露与长期不良神经发育相关。我们的目的是评估新生儿皮质醇浓度与生长和神经发育的长期结果之间的关系。作为氢化可的松治疗预防相对肾上腺功能不全的多中心随机试验的一部分，在出生后12至48小时和第5至7天对350名插管ELBW婴儿测定皮质醇浓度，其中252例存活，并在矫正年龄18至22个月时返回接受神经发育随访。将每个时间点的皮质醇值分成四分位数。生长和神经发育的结果进行了比较，为每个quartile.Result：中位皮质醇值为16.0微克每100毫升在基线的所有婴儿，和13.1微克每100毫升在第5天至第7天的安慰剂组。治疗组和安慰剂组的结果在每个四分位数上没有差异。基线或第5 - 7天的低皮质醇值与18 - 22个月矫正年龄的生长或神经发育受损无关。高皮质醇值与脑瘫的增加，严重的脑室内出血（IVH）和脑室周围leukomalacia.Conclusion的发病率增加相关：低皮质醇浓度不能预测不良的长期结果。高皮质醇浓度，虽然预测短期不良后果，如IVH和脑室周围白质软化，没有额外的预测不良后果。进一步分析确定出生后不久调节皮质醇浓度的因素，可以提高我们识别那些最有可能从氢化可的松治疗中受益的婴儿的能力。Journal of Perinatology（2010）30，484-488; doi：10.1038/jp.2009.191; 2009年12月10日在线发表
Objective: Both excess and insufficient levels of glucocorticoid in extremely low birth weight (ELBW) infants have been associated with adverse hospital outcomes, whereas excess glucocorticoid exposure has been associated with long-term adverse neurodevelopment. Our objective was to evaluate the relationship between neonatal cortisol concentrations and long-term outcomes of growth and neurodevelopment.Study Design: As part of a multicenter randomized trial of hydrocortisone treatment for prophylaxis of relative adrenal insufficiency, cortisol concentrations were obtained at 12 to 48 h of postnatal age and at days 5 to 7 on 350 intubated ELBW infants, of whom 252 survived and returned for neurodevelopmental follow-up at 18 to 22 months corrected age. Cortisol values from each time point were divided into quartiles. Growth and neurodevelopmental outcome were compared for each quartile.Result: Median cortisol value was 16.0 mu g per 100 ml at baseline for all infants, and 13.1 mu g per 100 ml on days 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 at days 5 to 7 were not associated with impaired growth or neurodevelopment at 18 to 22 months corrected age. High cortisol values were associated with an increase in cerebral palsy, related to the increased incidence of severe intraventricular hemorrhage (IVH) and periventricular leukomalacia.Conclusion: Low cortisol concentrations were not predictive of adverse long-term outcomes. High cortisol concentrations, although predictive of short-term adverse outcomes such as IVH and periventricular leukomalacia, did not additionally predict adverse outcome. Further analysis into identifying factors that modulate cortisol concentrations shortly after birth could improve our ability to identify those infants who are most likely to benefit from treatment with hydrocortisone. Journal of Perinatology (2010) 30, 484-488; doi: 10.1038/jp.2009.191; published online 10 December 2009