Document Detail


Early cortisol values and long-term outcomes in extremely low birth weight infants.
MedLine Citation:
PMID:  20010616     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 microg per 100 ml at baseline for all infants, and 13.1 microg 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.
Authors:
S W Aucott; K L Watterberg; M L Shaffer; P K Donohue;
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Publication Detail:
Type:  Journal Article     Date:  2009-12-10
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  30     ISSN:  1476-5543     ISO Abbreviation:  J Perinatol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-29     Completed Date:  2010-11-16     Revised Date:  2013-04-16    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  484-8     Citation Subset:  IM    
Affiliation:
Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287-3200, USA. saucott1@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenal Insufficiency / blood*,  drug therapy
Anti-Inflammatory Agents / administration & dosage
Female
Humans
Hydrocortisone / administration & dosage,  blood*
Infant, Extremely Low Birth Weight / blood*
Infant, Newborn
Male
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 HD038540/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 50-23-7/Hydrocortisone
Investigator
Investigator/Affiliation:
Kristi L Watterberg / ; Jeffrey S Gerdes / ; Cynthia H Cole / ; Susan W Aucott / ; Elizabeth H Thilo / ; Mark C Mammel / ; Robert J Couser / ; Jeffery S Garland / ; Henry J Rozycki / ; Corinne L Leach / ; Conra Backstrom / ; Michele L Shaffer /
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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