Adrenal Insufficiency in Ill Newborn
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- Category: Vol. 80, June 2012
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Adrenal Insufficiency in Ill Newborn,ALI EL-GAYAR and MANAL MARASHLI
Abstract
Cortisol release is considered vital in face of stress or illness. Activation of the hypothalamic pituitary adrenal axis (HPA) and ultimate release of cortisol is critical in maintaining homeostasis in response to stress. Recently, increasing evidence supports the existence of relative adrenal insufficiency in ill newborns.
Aim of the Study: Explore the relation between serum concentrations of adrenocorticotrophic hormone (ACTH) and cortisol in relation to severity of disease in ill preterm and full term newborn.
Patients and Methods: A cross section study on a total of 120 cases !914 days old divided into 4 groups, Group (A) include 30 ill preterm NB, Group (B) include 30 healthy preterm NB as a control, Group (C) include 30 ill full term and Group (D) include 30 healthy full term as a control. Every case will be subjected to: Thorough history taking, full physical examination including general and systemic examination, reporting management. Laboratory tests includes: Cortisol, ACTH, CBC, CRP, blood cultures for gram positive and negative organism and fungus.
Results: Sex of newborn has no effect on cortisol values, birth weight alone did not have a significant effect on cortisol values, there is statistically significant high proportion of incidence of PROM, fetal distress and resuscitation effort between ill & healthy preterm, and between ill & healthy fullterm newborn, we found significant association between serum cortisol and the lowest blood pressure registered in the immediate postnatal period, this correlation was independent of gestational age and birth weight. Significant statistical value was found between groups A and B, difference between groups C and D was also of statistical significance, ACTH (pmol/L) values for groups A & C were far below reference range. The mean and range values of cortisol (nmol/L) showed statistical significance value between groups A and B, signif-icant statistical value was also found between groups C and D, our results showed that group A & C had basal cortisol concentrations below the threshold values used to define relative adrenal insufficiency. Basal ACTH & cortisol values for both ill & healthy preterm were below values for ill & healthy fullterm.
Conclusion: This study showed that a significant evidence of inadequate adrenal function in the ill preterm and fullterm newborn especially with refractory hypotension confirming the importance of evaluation of adrenal function and gluco-corticoid therapy.