Absence of relationship between serum cortisol and critical illness in premature infants.
Absence of relationship between serum cortisol and critical illness in premature infants.
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DOI：
10.1136/archdischild-2020-319970
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Bernier A
中科院分区：
文献类型：
--
作者：
Prelipcean I;Wynn JL;Thompson L;Burchfield DJ;James-Woodley L;Chase PB;Barnes CP;Bernier A
极早产儿在危重疾病中皮质醇产生不足可能会加剧不良结局。尽管通常测量皮质醇浓度和管理氢化可的松假定肾上腺皮质功能不全，血清皮质醇浓度和疾病严重程度之间的关系仍然不清楚，在这个独特的人群。通过新生儿急性生理学评分（SNAP-II）、新生儿序贯器官衰竭评估（nSOFA）和血管活性-正性肌力评分（维斯）测定早产儿皮质醇浓度与疾病严重程度之间的关系。这项回顾性、单中心队列研究包括2011年6月至2018年7月期间入住IV级NICU的胎龄<30周的早产儿，他们在月经后36周之前获得了用于临床指征的血清皮质醇。收集了婴儿和母亲的人口统计学数据。九个临床变量被确定为先验，可能会改变皮质醇浓度，包括危重病。单变量和多变量分析确定皮质醇浓度和这些变量之间的关系。共有224名治疗前血清皮质醇浓度符合纳入标准的早产儿。出生时的中位（IQR）胎龄为25周（24，26），皮质醇测量时为26周（25，28）。皮质醇中位数为13.3 ug/dL。非幸存者的数值最高。皮质醇浓度与任何选定的疾病严重程度评分无关。无论胎龄如何，极早产儿的皮质醇浓度与疾病严重程度无关。需要进一步的研究来确定临床上有用的肾上腺功能障碍的介质，并指导临床管理。
Inadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship between serum cortisol concentration and illness severity remains unclear in this unique population. To determine the relationship between cortisol concentrations and illness severity as measured by the Score for Neonatal Acute Physiology (SNAP-II), neonatal Sequential Organ Failure Assessment (nSOFA), and Vasoactive-Inotropic Score (VIS) in premature infants. This retrospective, single-center cohort study included preterm infants born <30 weeks gestational age admitted to a level IV NICU between June 2011 - July 2018, who had a serum cortisol obtained for clinical indications before 36 weeks post-menstrual age. Demographic data were collected on infants and mothers. Nine clinical variables were identified a priori that could potentially modify cortisol concentration including critical illness. Univariate and multivariable analyses determined the relationship between cortisol concentration and each of these variables. A total of 224 preterm infants with pretreatment serum cortisol concentration met criteria for inclusion. The median (IQR) gestational age at birth was 25 weeks (24, 26) and at cortisol measurement was 26 weeks (25, 28). The median cortisol was 13.3 ug/dL. Non-survivors had the highest values. Cortisol concentration did not correlate with any of the selected illness severity scores. Cortisol concentrations in extremely preterm infants did not correlate with illness severity regardless of gestational age. Further studies are needed to identify clinically useful mediators of adrenal dysfunction and to guide clinical management.
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影响因子：
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