Cortisol production rates in preterm infants in relation to growth and illness:: A noninvasive prospective study using gas chromatography-mass spectrometry
Cortisol production rates in preterm infants in relation to growth and illness:: A noninvasive prospective study using gas chromatography-mass spectrometry
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DOI：
10.1210/jc.2005-0870
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发表时间：
2005-10-01
影响因子：
5.8
通讯作者：
Wudy, SA
中科院分区：
文献类型：
--
作者：
Heckmann, M;Hartmann, MF;Wudy, SA
内容：而宫内生长和成熟依赖于低皮质醇水平，肾上腺应激反应postnatally被认为是强制性的早产infants.Objective：本研究的目的是确定皮质醇生产率（CPRs）在早产儿在生命早期的极端疾病，此后，在子宫外的生长和成熟。设计图：我们描述了一个纵向的观察study.Setting：这项研究是在一所大学的新生儿重症监护室进行的。患者和方法：17个良好（27.9 +/- 1.8周）和44个生病（27.3 +/- 1.6周）早产儿进行了分类的新生儿急性生理评分。通过气相色谱-质谱法分析24小时尿液样本中的糖皮质激素代谢产物。使用纤维素尿布非侵入性地收集尿液，并通过液压机提取。（μ g kg（-1）d（-1）mg肌酐）在患病（健康）早产儿中如下：d1，35（40）; d2，35（40）; d3，48（53）; d5，47（41）; wk 2，72（48）;第3周，73（37）;第4周，54（26）。回归分析显示，胎龄（P < 0.005）对CPR的最大值有显著的负向影响，但对疾病的严重程度无显著影响（新生儿急性生理学评分; P = 0.72）。在44例早产儿中，只有12例（27%）出现了成熟的肾上腺反应，这些早产儿的CPR比健康婴儿的CPR中位数高3倍。这种成熟的肾上腺反应与脑出血的发生率显著升高相关：12例患者中有9例（75%），而无这种反应的32例患者中有8例（25%）（P = 0.003）。在生长发育过程中，患病（健康）早产儿的CPRs下降：2个月30例（18例），3个月18例（22例）;患病早产儿体重增加与CPRs下降的相关性在第4周和第3个月之间，r = -0.48（P = 0.027）。然而，最高的CPR与脑出血的发生率显著较高相关。在生长过程中，CPRs显著下降，表明早产儿有能力调节皮质醇的产生。患病早产儿的CPR可能反映了应激反应不足，但这也可能揭示了胎儿对高分解代谢皮质醇浓度的保护机制的持久性。
Context: Whereas intrauterine growth and maturation depend on low cortisol levels, an adrenal stress response postnatally is thought to be mandatory in preterm infants.Objective: The goal of this study was to determine cortisol production rates (CPRs) in preterm infants during early life with extreme illness and, thereafter, during extrauterine growth and maturation. Design: We describe a longitudinal observational study.Setting: The study was conducted at a university neonatal intensive care unit.Patients and Methods: Seventeen well (27.9 +/- 1.8 wk) and 44 ill (27.3 +/- 1.6 wk) preterm infants were classified by the Score for Neonatal Acute Physiology. Glucocorticoid metabolites were profiled by gas chromatography-mass spectrometry in 24-h urinary samples. Urine was collected noninvasively using cellulose nappies and extracted by hydraulic press.Results: Medians of CPRs (mu g kg(-1)d(-1)mg creatinine) in ill (well) preterm infants were as follows: at d 1, 35 (40); d 2, 35 (40); d 3, 48 53); d 5, 47 ( 41); wk 2, 72 ( 48); wk 3, 73 ( 37); wk 4, 54 ( 26). Regression analysis revealed a significant inverse influence of gestational age ( P < 0.005) on the maximum of CPRs but not of severity of illness ( Score for Neonatal Acute Physiology; P = 0.72). A mature adrenal response was found in only 12 of 44 (27%) ill preterm infants, who had CPRs higher than the 3-fold median of CPRs of well infants. This mature adrenal response was associated with a significantly higher incidence of cerebral bleeding: 9 of 12 (75%) vs. 8 of 32 (25%) without such a response ( P = 0.003). During growth, CPRs of ill ( well) preterm infants decreased: at month 2, 30 ( 18); month 3, 18 ( 22); correlation between weight gain and decrease of CPRs in ill infants between wk 4 and month 3, r = -0.48 ( P = 0.027).Conclusions: Severity of illness did not have a significant influence on CPRs in preterm infants. However, the highest CPRs were associated with a significantly higher incidence of cerebral bleeding. During growth, CPRs decreased significantly, suggesting that preterm infants have the ability to regulate cortisol production. CPRs in ill preterm infants might reflect inadequate stress reaction, but this could also reveal persistence of fetal protective mechanisms against high catabolic cortisol concentrations.