Fernandez Erika, Schrader Ron, Watterberg Kristi
Department of Pediatrics/Neonatology (E.F., K.W.), The University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA.
J Perinatol. 2005 Feb;25(2):114-8. doi: 10.1038/sj.jp.7211211.
To determine the prevalence of low cortisol values and to evaluate clinical responses to hydrocortisone in ill term and near-term newborns.
Retrospective cohort study including infants >or=35 weeks gestational age who were mechanically ventilated, received vasopressor therapy, and had a cortisol concentration obtained for evaluation of vasopressor-resistant hypotension. In those infants treated with hydrocortisone, physiologic responses were evaluated and correlated with cortisol values (<15 vs >or=15 microg/dl).
A total of 32 infants had cortisol values obtained; 18 (56%) were <15 microg/dl. In all, 21 infants were treated with hydrocortisone of whom 13 had cortisol values <15 microg/dl. These 13 infants showed decreased heart rate, dopamine support and fluid bolus requirements after treatment, compared to infants with values >or=15 microg/dl (n=8).
A significant number of hypotensive, mechanically ventilated infants have evidence of inadequate adrenal function. Hydrocortisone therapy resulted in hemodynamic stabilization in this population.
确定低皮质醇值的患病率，并评估足月儿和近足月儿对氢化可的松的临床反应。
回顾性队列研究，纳入孕周≥35周、接受机械通气、接受血管升压药治疗且检测皮质醇浓度以评估血管升压药抵抗性低血压的婴儿。对接受氢化可的松治疗的婴儿，评估其生理反应并与皮质醇值（<15 vs ≥15μg/dl）进行关联分析。
共32例婴儿检测了皮质醇值；18例（56%）<15μg/dl。总计21例婴儿接受了氢化可的松治疗，其中13例皮质醇值<15μg/dl。与皮质醇值≥15μg/dl的婴儿（n = 8）相比，这13例婴儿治疗后心率、多巴胺支持量和液体推注需求量均降低。
大量低血压、机械通气的婴儿存在肾上腺功能不足的证据。氢化可的松治疗可使该人群血流动力学稳定。
