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Levothyroxine replacement therapy and refractory hypotension out of transitional period in preterm infants.
MedLine Citation:
PMID:  21070313     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background  Recent studies suggest that refractory hypotension from causes other than septicaemia or cardiac failure is common in extremely preterm infants even out of the transitional period. Marked response to low-dose cortisol suggests underlying adrenal insufficiency, although the exact mechanism remains unknown. Methods  To investigate potential triggers for and related short-term outcomes of early-onset (<Day 7) and late-onset (≥Day 7) refractory hypotension, clinical data for 70 infants <30 weeks gestation were assessed. Results  The incidence of early-onset refractory hypotension (n = 7) was correlated with younger gestational ages <26 weeks (P < 0·05), whereas the incidence of late-onset refractory hypotension (n = 14) was correlated with younger gestational ages and levothyroxine supplementation (P < 0·05 and 0·01, respectively). The incidence of both early- and late-onset refractory hypotension was correlated with risks of short-term adverse outcomes such as prolonged mechanical ventilation and hospital stay. Conclusions  Levothyroxine supplementation was identified as an independent variable correlated with an increased incidence of refractory hypotension out of the transitional period; as seen in hypothyroidism with Addison's disease, the immature hypothalamic-pituitary-adrenal axis may not respond properly to the increased demand for cortisol, which may precipitate premature infants into refractory hypotension. Following the administration of levothyroxine, preterm infants may have to be carefully monitored for early signs of refractory hypotension.
Authors:
Junichiro Okada; Sachiko Iwata; Akiko Hirose; Hiroshi Kanda; Makoto Yoshino; Yasuki Maeno; Toyojiro Matsuishi; Osuke Iwata
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  74     ISSN:  1365-2265     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  354-64     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Department of Paediatrics and Child Health Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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