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Association between plasma cortisol and death or vasopressor refractory hypotension in preterm neonates: a prospective, cohort study

Journal of Perinatology volume 38, pages 672–680 (2018)Cite this article

Subjects

Abstract

Objectives:

Temporal relation between adrenal insufficiency and hypotension is poorly understood. We examined the association between basal and post-stimulation cortisol and death or vasopressor refractory hypotension in preterm neonates.

Study Design:

Prospective cohort study in ≤30 weeks’ and/or <1,250 g weight. Primary outcome-composite of death or vasopressor refractory hypotension by day 14 of life. Plasma cortisol levels were measured at 24–36 h (T1), 72–84 h (T2) and 10 days (T3), and post-stimulation cortisol at T1 and later at T2 and T3 if the adrenal response was inadequate earlier.

Results:

Basal cortisol (µg/dl) at 24–36 h was significantly higher in the outcome group (37.2 ± 21.1 vs. 22.04 ± 14.6; mean difference (MD) (95% confidence interval (CI)): −15.1 (−23.6, −6.6); p = 0.005). High basal cortisol at 24–36 h (odds ratio (OR) (95% CI): 1.044 (1.009, 1.079); p = 0.01) and need for ventilation (OR (95% CI): 9.7 (1.2, 81.2); p = 0.04) independently increased the risk of death or vasopressor refractory hypotension.

Conclusion:

Preterm neonates who died or developed vasopressor refractory hypotension by day 14 had significantly elevated basal cortisol at 24–36 h of life.

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Acknowledgements

Funding

A special research grant of 100,000 INR was awarded by the Research Grant Cell of the Postgraduate Institute of Medical Education and Research, Chandigarh, India (internal funding) and a thesis financial grant of 25,000 INR by the Indian Council of Medical Research, New Delhi. These funds were utilized for the purchase of ECLIA kits for analysis of plasma cortisol and ACTH. However, both the organizations did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Monisha Rameshbabu, Venkataseshan Sundaram, Shiv Sajan Saini & Sourabh Dutta

  2. Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Naresh Sachdeva & Rama Walia

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  1. Monisha Rameshbabu
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Correspondence to Venkataseshan Sundaram.

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Rameshbabu, M., Sundaram, V., Sachdeva, N. et al. Association between plasma cortisol and death or vasopressor refractory hypotension in preterm neonates: a prospective, cohort study. J Perinatol 38, 672–680 (2018). https://doi.org/10.1038/s41372-018-0059-1

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