Assessing cortisol production in preterm infants:: Do not dispose of the nappies
Assessing cortisol production in preterm infants:: Do not dispose of the nappies
复制标题
DOI：
10.1203/01.pdr.0000153947.51642.c1
复制
发表时间：
2005-03-01
影响因子：
3.6
通讯作者：
Wudy, SA
中科院分区：
文献类型：
--
作者：
Heckmann, M;Hartmann, MF;Wudy, SA
本研究的目的是开发一种实用方法，能够对早产儿的皮质醇生成率进行可靠且无创的评估。为了测量糖皮质激素的每日尿排泄率，我们开发了一种使用液压压缩方法从纤维素尿布（尿布）中收集尿液的程序。通过定量气相色谱-质谱法分析糖皮质激素代谢物。从尿布中进行水力提取后，类固醇的回收率约为 100%。接下来，可以测定九名健康早产儿的尿糖皮质激素排泄率。糖皮质激素的中位尿排泄率在出生后前 5 天显着增加，并保持在第 5 天的 566 微克/公斤/天和第 4 周时的 302 微克/公斤/天之间。然而，在校正肌酐排泄后，出生后最初几天糖皮质激素尿排泄率的增加不再显着。按每平方米体表面积计算，糖皮质激素的中位尿排泄率在第 5 天、第 2、3 和 4 周分别为 5.1、4.2、4.1 和 3.7 mg/m(2)/d。根据大龄儿童稳定同位素稀释技术测定，糖皮质激素的尿排泄率约占天然皮质醇生成率的 70%。此外，五名患有动脉低血压、需要儿茶酚胺治疗的早产儿中，有两人检测到皮质醇分泌量低。总之，使用一次性尿布收集 24 小时尿液并结合气相色谱-质谱法类固醇分析被证明是评估早产儿皮质醇产生和代谢的可靠、无创、无压力的程序。
The aim of this study was to develop a practical approach allowing a reliable and noninvasive assessment of cortisol production rates in premature infants. To measure daily urinary excretion rates of glucocorticoids, we developed a procedure using a hydraulic compression method to collect urine from cellulose nappies (diapers). Glucocorticoid metabolites were profiled by quantitative gas chromatography-mass spectrometry. Recovery of steroids after the process of hydraulic extraction from the nappy was approximately 100%. Consecutively, urinary excretion rates of glucocorticoids could be determined in nine healthy preterm infants. The median urinary excretion rate of glucocorticoids increased significantly during the first 5 d of life and remained between 566 mug/kg/d at d 5 and 302 mug/kg/d at 4 wk of age. However, this increase of urinary excretion rates of glucocorticoids in the first days of life was no longer significant when corrected for creatinine excretion. When calculated per square meter body surface area, the median urinary excretion rates of glucocorticoids were 5.1, 4.2, 4.1, and 3.7 mg/m(2)/d on d 5, and at wk, 2, 3, and 4, respectively. Urinary excretion rates of glucocorticoids constitute approximately 70% of the natural cortisol production rate as determined by stable isotope dilution technique in older children. Additionally, low cortisol production was detected in two of five preterm infants with arterial hypotension requiring treatment with catecholamines. In conclusion, 24-h urine collection using disposable nappies in combination with gas chromatography-mass spectrometry steroid profiling proved to be a reliable, noninvasive, nonstressful procedure to assess cortisol production and metabolism in premature infants.