J Korean Soc Neonatol.  2011 May;18(1):82-88. 10.5385/jksn.2011.18.1.82.

Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants

• Choi EJ
• Sohn JA
• Lee EH
• Lee JY
• Lee HJ
• Chung HR
• Lee JA
• Choi CW
• Kim EK
• Kim HS
• Kim BI
• Choi JH

• KMID: 2188470
• DOI: http://doi.org/10.5385/jksn.2011.18.1.82

Abstract

PURPOSE
This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes.
METHODS
Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively.
RESULTS
Gestational age was 27.8+/-2.5 weeks and birth weight was 1,110+/-307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19+/-7 day, 30.6+/-2.4 weeks, 1,285+/-365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2+/-0.7 days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6+/-4.1 mg/dL. Mean blood pressure increased from 25.0+/-5.4 mmHg to 35.0+/-5.3 mmHg, 38.3+/-8.0 mmHg and 41.9+/-6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9+/-0.6 mL/kg/hr to 4.1+/-3.4 mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0+/-2.9 microg/kg/min to 8.0+/-2.3 microg/kg/min, and to 5.5+/-3.4 microg/kg/min after 24 hours. Serum sodium concentration was increased from 130+/-4 mEq/L to 136+/-4 mEq/L, serum potassium concentration was decreased from 6.1+/-1.1 mEq/L to 4.6+/-0.6 mEq/L before and 12 hours after hydrocortisone administration.
CONCLUSION
In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.

Keyword

Hypotension; Adrenal insufficiency; Hydrocortisone

MeSH Terms

Adrenal Insufficiency
Birth Weight
Blood Pressure
Cardiovascular System
Dopamine
Gestational Age
Humans
Hydrocortisone
Hypotension
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal
Potassium
Sodium
Dopamine
Hydrocortisone
Potassium
Sodium