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The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants

Journal of Perinatology volume 32, pages 412–417 (2012)Cite this article

Subjects

Abstract

Objective:

To investigate if in preterm newborns, an early adrenocorticotropin hormone (ACTH) test can identify possible transient adrenal insufficiency (TAI), using significant hypotension as a clinical marker.

Study Design:

We studied 40 premature newborns born 24 to 29 weeks gestational age (GA) before 8 h of life. Serum cortisol levels were obtained before and 40 min after administration of 1.0 mcg kg−1 cosyntropin. Inotropes were used to treat hypotension based on clinical assessment following no response to fluid boluses. Functional echocardiogram was used to support the clinical diagnosis of hypotension. The accuracy of the ACTH test was evaluated using receiver operating characteristic (ROC) curve.

Result:

Study patients had mean GA of 26.6 weeks and birth weight of 876 g. In all, 30% required inotropes. The area under the ROC curve for the ACTH test was 87%. Using a cutoff of an increase in cortisol below 12% from baseline had 75% sensitivity and 93% specificity for detecting hypotension. This cutoff was associated with bronchopulmonary dysplasia (8/12 vs 7/28, 95% CI: 0.1 to 0.72), but not with other morbidities or death.

Conclusion:

An early ACTH test using the above cutoff has high specificity for detecting hypotension, and thus, can serve as a marker for potential TAI in preterm newborns. Future studies should focus on identifying those newborns for which steroid supplementation would be most beneficial.

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Acknowledgements

We thank Dr M Whitfield for his helpful suggestions in writing of the manuscript.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada

    O Hochwald, L Holsti & H Osiovich

  2. Neonatal Intensive Care Unit, Bnai Zion medical Center, Haifa, Israel

    O Hochwald

  3. Department of Occupational Science and Occupational Therapy, UBC, Vancouver, BC, Canada

    L Holsti

  4. Child and Family Research Institute, Vancouver, BC, Canada

    L Holsti

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Correspondence to O Hochwald.

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Hochwald, O., Holsti, L. & Osiovich, H. The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants. J Perinatol 32, 412–417 (2012). https://doi.org/10.1038/jp.2012.16

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