Umbilical cord blood cortisol levels and hemodynamic status on the first day of life in preterm infants less than 32 weeks gestation
CPS ePoster Library. Yusuf K. 06/25/15; 99168; 106
Kamran Yusuf
Kamran Yusuf
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Abstract
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Background: Adrenal insufficiency is an important contributor to hemodynamic instability in preterm infants during the first few days of life. Preterm infants hypotensive on day 1 may have an innate inability to mount an adrenal response to stress, which can be studied by measuring umbilical cord cortisol levels.

Objective: To compare cord blood cortisol levels between infants <32 weeks gestation who need fluid bolus or inotropic support (F/I group) in the first 24 hours of life and infants who do not need such support (No F/I group).

Methods: This was a prospective observational study on infants <32 weeks gestation. Blood was drawn from the umbilical vein within 30 minutes of birth and cortisol was assayed using ELISA. Use of fluid bolus or inotrope in the first 24 hours of life was used as a marker for hemodynamic instability. The criteria for use of fluid boluses and inotropes are consistent in our unit. Cortisol levels were compared between the F/I and No F/I groups. Statistical analysis was performed using a two way non-paired Student t test or Mann-Whitney test and χ2 or Fisher's exact test as appropriate.

Results:
F/I(n=25) No F/I(n=68) p value
Cortisol ng/ml median(IQR) 82(77) 118(64) 0.33
ANCS n,% 22(88) 67(99) 0.02
Preeclampsia n,% 2(8) 5(7) 0.49
C-section n % 15(60) 37(54) 0.63
Gestational age (wks) mean±SD 26.9±2.2 28.4±2.2 0.007
Birth weight (g) mean±SD 1032±290 1185±360 0.03
Chorioamnionitis n, % 16(64) 37(54) 0.41
<10th percentile for BW n,% 1(4) 7(10) 0.34
Male n,% 16(64) 35(51) 0.28
Respiratory distress syndrome n,% 24(96) 47(69) 0.007
Grade 3/4 IVH n,% 7(28) 6(9) 0.01
SNAPPE-II mean±SD 36±24 13±16 0.000
Mortality n,% 4(16) 2 (3) 0.02

Infants in F/I group were more preterm, smaller, and received less antenatal corticosteroids (ANCS) and had significantly higher SNAPPE-II scores and rates of IVH, RDS, and mortality. Umbilical cortisol levels did not correlate with mean blood pressures at 1, 6, 12 and 24 hours of life. There was no effect of chorioamnionitis or mode of delivery (MOD) on cortisol levels.

Conclusion: Umbilical cortisol levels in hemodynamically unstable preterm infants are not different from those in well preterm infants. We speculate that, unlike what is reported with term infants, preterm infants do not respond adequately to stressors like intrauterine infection and labor.
Background: Adrenal insufficiency is an important contributor to hemodynamic instability in preterm infants during the first few days of life. Preterm infants hypotensive on day 1 may have an innate inability to mount an adrenal response to stress, which can be studied by measuring umbilical cord cortisol levels.

Objective: To compare cord blood cortisol levels between infants <32 weeks gestation who need fluid bolus or inotropic support (F/I group) in the first 24 hours of life and infants who do not need such support (No F/I group).

Methods: This was a prospective observational study on infants <32 weeks gestation. Blood was drawn from the umbilical vein within 30 minutes of birth and cortisol was assayed using ELISA. Use of fluid bolus or inotrope in the first 24 hours of life was used as a marker for hemodynamic instability. The criteria for use of fluid boluses and inotropes are consistent in our unit. Cortisol levels were compared between the F/I and No F/I groups. Statistical analysis was performed using a two way non-paired Student t test or Mann-Whitney test and χ2 or Fisher's exact test as appropriate.

Results:
F/I(n=25) No F/I(n=68) p value
Cortisol ng/ml median(IQR) 82(77) 118(64) 0.33
ANCS n,% 22(88) 67(99) 0.02
Preeclampsia n,% 2(8) 5(7) 0.49
C-section n % 15(60) 37(54) 0.63
Gestational age (wks) mean±SD 26.9±2.2 28.4±2.2 0.007
Birth weight (g) mean±SD 1032±290 1185±360 0.03
Chorioamnionitis n, % 16(64) 37(54) 0.41
<10th percentile for BW n,% 1(4) 7(10) 0.34
Male n,% 16(64) 35(51) 0.28
Respiratory distress syndrome n,% 24(96) 47(69) 0.007
Grade 3/4 IVH n,% 7(28) 6(9) 0.01
SNAPPE-II mean±SD 36±24 13±16 0.000
Mortality n,% 4(16) 2 (3) 0.02

Infants in F/I group were more preterm, smaller, and received less antenatal corticosteroids (ANCS) and had significantly higher SNAPPE-II scores and rates of IVH, RDS, and mortality. Umbilical cortisol levels did not correlate with mean blood pressures at 1, 6, 12 and 24 hours of life. There was no effect of chorioamnionitis or mode of delivery (MOD) on cortisol levels.

Conclusion: Umbilical cortisol levels in hemodynamically unstable preterm infants are not different from those in well preterm infants. We speculate that, unlike what is reported with term infants, preterm infants do not respond adequately to stressors like intrauterine infection and labor.
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