O Hochwald1, L Holsti, H Osiovich. 1. Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.
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.
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.
Authors: Ronald I Clyman; Andrea Wickremasinghe; T Allen Merritt; Tabitha Solomon; Patrick McNamara; Amish Jain; Jaideep Singh; Alison Chu; Shahab Noori; Krishnamurthy Sekar; Pascal M Lavoie; Joshua T Attridge; Jonathan R Swanson; Maria Gillam-Krakauer; Jeff Reese; Sara DeMauro; Brenda Poindexter; Sue Aucott; Monique Satpute; Erika Fernandez; Richard J Auchus Journal: J Pediatr Date: 2014-03-15 Impact factor: 4.406
Authors: Melissa Catenacci; Shogo Miyagi; Andrea C Wickremasinghe; Sarah Scarpace Lucas; Alejandra G de Alba Campomanes; William V Good; Ronald I Clyman Journal: J Pediatr Date: 2013-03-01 Impact factor: 4.406