Khashana Abdelmoneim, Ahmed Hoda, Ahmed Amal, Abdelwahab Amina, Saarela Timo, Rämet Mika, Hallman Mikko
a Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu , Oulu , Finland.
b Department of Children and Adolescents , Oulu University Hospital , Oulu , Finland.
J Matern Fetal Neonatal Med. 2018 Sep;31(18):2473-2477. doi: 10.1080/14767058.2017.1344966. Epub 2017 Jul 11.
To correlate between cortisol precursors in neonates with vasopressor resistant hypotension and demographic characteristics.
We investigated 48 neonates with vasopressor-resistant hypotension. Gestation at birth ranged from 34 to 42 weeks and postnatal age from 4 to 14 days. Cortisol and precursor steroids were measured soon after the onset of volume expansion and inotropes for treatment of shock. Their concentrations were determined using liquid chromatography/mass spectrometry.
In neonates with vasopressor-resistant hypotension, the serum levels of cortisol were within normal nonstress range. There was a strong negative linear association between postnatal age and dehydroepiandrosterone level (r = -0.50, p < .01), which decreased with neonatal age. In addition, there was a significant positive association between gestational age at birth and 17-hydroxy-pregnenolone (r = 0.33, p = .02). No further significant associations were evident between the neonatal weight, duration of gestation or gender and of the levels of cortisol or the other steroids (p > .05). The cause of therapy-resistant hypotension did not appear to influence the steroid levels.
Cortisol stress response is absent in these severely ill late preterm and term infants. This may be due to inhibition of the distal pathway of cortisol synthesis.
探讨新生儿中皮质醇前体与血管升压药抵抗性低血压及人口统计学特征之间的相关性。
我们研究了48例患有血管升压药抵抗性低血压的新生儿。出生时孕周为34至42周，出生后年龄为4至14天。在扩容和使用正性肌力药物治疗休克后不久，测量皮质醇和前体类固醇。使用液相色谱/质谱法测定其浓度。
在患有血管升压药抵抗性低血压的新生儿中，皮质醇的血清水平在正常非应激范围内。出生后年龄与脱氢表雄酮水平之间存在强烈的负线性关联（r = -0.50，p <.01），且随着新生儿年龄的增加而降低。此外，出生时的孕周与17-羟孕烯醇酮之间存在显著的正相关（r = 0.33，p =.02）。新生儿体重、孕周或性别与皮质醇或其他类固醇水平之间没有进一步的显著关联（p >.05）。治疗抵抗性低血压的原因似乎不影响类固醇水平。
这些重症晚期早产儿和足月儿不存在皮质醇应激反应。这可能是由于皮质醇合成远端途径受到抑制。
