Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Factors Influencing Levels of 17-Hydroxyprogesterone in Very Low Birth Weight Infants and the Relationship to Death and IVH

Journal of Perinatology volume 24, pages 252–256 (2004)Cite this article

Abstract

OBJECTIVES: 17-Hydroxyprogesterone, an intermediary hormone in cortisol synthesis, has been shown to be elevated in premature infants. However, the relationship between levels of 17-hydroxyprogesterone with death and intraventricular hemorrhage has not been extensively explored. The objective of this study was to determine the factors influencing 17-hydroxyprogesterone and determine if there is an association between intraventricular hemorrhage, mortality, and levels of 17-hydroxyprogesterone in a population of very low birth weight infants.

STUDY DESIGN: Cohort study of very low birth weight infants cared for at a single level 3 NICU during a 1-year period from July 2001 to July 2002. Infants had a minimum of one screen for 17-hydroxyprogesterone and one cranial sonogram. 17-Hydroxyprogesterone was measured on the fifth day of life and at 2 to 4 weeks of life as part of the State of Delaware Newborn Screening Program. Statistical analysis included χ2, Pearson correlation, multiple-linear regression, and logistic regression.

RESULTS: Levels of 17-hydroxyprogesterone were higher at the time of the first screen compared to the second screen (28.3±25.6 vs 17.0±18.0 ng/ml, p=0.01), respectively. After controlling for potential confounding variables, gestational age, T4, and prenatal steroids were all independently associated with 17-hydroxyprogesterone. However, logistic regression analysis showed no association between a 1 log increase in levels of 17-hydroxyprogesterone with the outcomes of death (odds ratio 1.8, 95% CI 0.6 to 5.6), severe IVH (0.7, 0.3 to 1.7), and death and/or severe intraventricular hemorrhage (0.9, 0.4 to 2.1).

CONCLUSIONS: In our population of very low birth weight infants, low gestational age, low T4, and prenatal steroids were all associated with an elevation in levels of 17-hydroxyprogesterone. High levels of 17-hydroxyprogesterone were not associated with death and/or severe IVH. Our data indicate that factors such as gestational age and antenatal steroids must be considered when interpreting 17-hydroxyprogesterone results from newborn screening.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. al Saedi S, Dean H, Dent W, Cronin C . Reference ranges for serum cortisol and 17-hydroxyprogesterone levels in preterm infants. J Pediatr 1995;126:985–987.

    Article  CAS  PubMed  Google Scholar 

  2. Hingre RV, Gross SJ, Hingre KS, Mayes DM, Richman RA . Adrenal steroidogenesis in very low birth weight preterm infants. J Clin Endocrinol Metab 1994;78:266–270.

    CAS  PubMed  Google Scholar 

  3. Watterberg KL, Gerdes JS, Cook KL . Impaired glucocorticoid synthesis in premature infants developing chronic lung disease. Pediatr Res 2001;50:190–195.

    Article  CAS  PubMed  Google Scholar 

  4. Banks BA, Stouffer N, Cnaan A, et al. Association of plasma cortisol and chronic lung disease in preterm infants. Pediatrics 2001;107:494–498.

    Article  CAS  PubMed  Google Scholar 

  5. Alexander JM, Gilstrap LC, Cox SM, McIntire DM, Leveno KJ . Clinical chorioamnionitis and the prognosis for very low birth weight infants. Obstet Gynecol 1998;91:725–729.

    CAS  PubMed  Google Scholar 

  6. Dammann O, Leviton A . Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res 1997;42:1–8.

    Article  CAS  PubMed  Google Scholar 

  7. Debillon T, Gras-Leguen C, Verielle V, et al. Intrauterine infection induces programmed cell death in rabbit periventricular white matter. Pediatr Res 2000;47:736–742.

    Article  CAS  PubMed  Google Scholar 

  8. Paul DA, Leef KH, Stefano JL . Increased leukocytes in infants with intraventricular hemorrhage. Pediatr Neurol 2000;22:194–199.

    Article  CAS  PubMed  Google Scholar 

  9. Paul DA, Leef KH, Stefano JL, Bartoshesky L . Low serum thyroxine on initial newborn screening is associated with intraventricular hemorrhage and death in very low birth weight infants. Pediatrics 1998;101:903–907.

    Article  CAS  PubMed  Google Scholar 

  10. Leviton A, Paneth N, Reuss ML, et al. Hypothyroxinemia of prematurity and the risk of cerebral white matter damage. J Pediatr 1999;134:706–711.

    Article  CAS  PubMed  Google Scholar 

  11. Reuss ML, Paneth N, Pinto-Martin JA, Lorenz JM, Susser M . The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age. N Engl J Med 1996;334:821–827.

    Article  CAS  PubMed  Google Scholar 

  12. Hadeed AJ, Asay LD, Klein AH, Fisher DA . Significance of transient postnatal hypothyroxinemia in premature infants with and without respiratory distress syndrome. Pediatrics 1981;68:494–498.

    CAS  PubMed  Google Scholar 

  13. Paul DA, Leef KH, Voss B, Stefano JL, Bartoshesky L . Thyroxine and illness severity in very low-birth-weight infants. Thyroid 2001;11:871–875.

    Article  CAS  PubMed  Google Scholar 

  14. van Wassenaer AG, Kok JH, Dekker FW, de Vijlder JJ . Thyroid function in very preterm infants: influences of gestational age and disease. Pediatr Res 1997;42:604–609.

    Article  CAS  PubMed  Google Scholar 

  15. Huysman MW, Hokken-Koelega AC, De Ridder MA, Sauer PJ . Adrenal function in sick very preterm infants. Pediatr Res 2000;48:629–633.

    Article  CAS  PubMed  Google Scholar 

  16. Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA . Score for neonatal acute physiology: a physiologic severity index for neonatal intensive care. Pediatrics 1993;91:617–623.

    CAS  PubMed  Google Scholar 

  17. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529–534.

    Article  CAS  PubMed  Google Scholar 

  18. Ballard JL, Khoury JC, Wedig K, et al. New Ballard score, expanded to include extremely premature infants. J Pediatr 1991;119:417–423.

    Article  CAS  PubMed  Google Scholar 

  19. Leon DA . Failed or misleading adjustment for confounding. Lancet 1993;342:479–481.

    Article  CAS  PubMed  Google Scholar 

  20. Watterberg KL, Scott SM, Naeye RL . Chorioamnionitis, cortisol, and acute lung disease in very low birth weight infants. Pediatrics 1997;99:E6.

    Article  CAS  PubMed  Google Scholar 

  21. Yoon BH, Romero R, Jun JK, et al. Amniotic fluid cytokines (interleukin-6, tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-8) and the risk for the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 1997;177:825–830.

    Article  CAS  PubMed  Google Scholar 

  22. Watterberg KL, Scott SM, Backstrom C, Gifford KL, Cook KL . Links between early adrenal function and respiratory outcome in preterm infants: airway inflammation and patent ductus arteriosus. Pediatrics 2000;105:320–324.

    Article  CAS  PubMed  Google Scholar 

  23. Barker PM, Markiewicz M, Parker KA, Walters DV, Strang LB . Synergistic action of triiodothyronine and hydrocortisone on epinephrine-induced reabsorption of fetal lung liquid. Pediatr Res 1990;27:588–591.

    Article  CAS  PubMed  Google Scholar 

  24. Biswas S, Buffery J, Enoch H, et al. Pulmonary effects of triiodothyronine (T(3)) and hydrocortisone (HC) supplementation in preterm infants less than 30 weeks gestation: results of the THORN trial — thyroid hormone replacement in neonates. Pediatr Res 2003;53:48–56.

    CAS  PubMed  Google Scholar 

  25. King JL, Naber JM, Hopkin RJ, et al. Antenatal corticosteroids and newborn screening for congenital adrenal hyperplasia. Arch Pediatr Adolesc Med 2001;155:1038–1042.

    Article  CAS  PubMed  Google Scholar 

  26. Ballard PL, Gluckman PD, Liggins GC, Kaplan SL, Grumbach MM . Steroid and growth hormone levels in premature infants after prenatal betamethasone therapy to prevent respiratory distress syndrome. Pediatr Res 1980;14:122–127.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, DE, USA

    David A Paul MD, Kathleen H Leef RN & John L Stefano MD

  2. Department of Pediatrics, duPont Hospital for Children, Wilmington, DE, USA

    Louis Bartoshesky MD

  3. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA

    David A Paul MD, John L Stefano MD & Louis Bartoshesky MD

Authors
  1. David A Paul MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen H Leef RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John L Stefano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Louis Bartoshesky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paul, D., Leef, K., Stefano, J. et al. Factors Influencing Levels of 17-Hydroxyprogesterone in Very Low Birth Weight Infants and the Relationship to Death and IVH. J Perinatol 24, 252–256 (2004). https://doi.org/10.1038/sj.jp.7211066

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211066

Search

Advanced search

Quick links