Abstract
Objectives
Determine incidence of preoperative adrenal insufficiency in neonates >35 weeks gestation with congenital heart disease undergoing cardiothoracic surgery with bypass and effects of prophylactic methylprednisolone on postoperative hypothalamic-pituitary-adrenal function and hemodynamic stability.
Design
Prospective observational study in 36 neonates with preoperative adrenocorticotrophic hormone stimulation tests and serial total cortisol and adrenocorticotrophic hormone measurements before and after surgery. Data analyses: analysis of variance and regression.
Results
Baseline circulating adrenocorticotrophic hormone and cortisol were unchanged 4–20 days postnatal (P > 0.1); however, cortisol levels rose with increasing adrenocorticotrophic hormone, P = 0.02. Ten neonates (29%) demonstrated preoperative adrenal insufficiency (∆cortisol ≤9 µg/dl); one had postoperative hemodynamic instability. Growth-restricted neonates had lower baseline cortisol, but normal stimulation tests and responded well to surgical stresses. Seventy-five percent of neonates receiving perioperative methylprednisolone demonstrated postoperative hypothalamic-pituitary-adrenal inhibition.
Conclusion
Adrenal insufficiency appears common in neonates >35 weeks gestation with congenital heart disease, but did not contribute to postoperative hemodynamic instability despite hypothalamic-pituitary-adrenal inhibition.
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Acknowledgements
We would like to thank the nursing staff in the CVICU who facilitated the collection of the blood samples and Dr. Joseph Forbess for access to his patients. Support for the study was provided by the Children’s Clinical Research Advisory Committee, Children’s Medical Center Foundation, and the George L MacGregor Professorship was awarded to CRR.
Funding
Research grant from the Children’s Clinical Research Advisory Committee, Children’s Medical Center Foundation to Michel Mikhael and the George L. MacGregor Professorship awarded to Charles Rosenfeld.
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Tang, A., Rosenfeld, C.R., Mikhael, M. et al. Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids. J Perinatol 39, 640–647 (2019). https://doi.org/10.1038/s41372-019-0344-7
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DOI: https://doi.org/10.1038/s41372-019-0344-7