Effects of dexamethasone on the hypothalamic-pituitary-adrenal axis in preterm infants

doi:10.1016/S0022-3476(05)81971-7

The Journal of Pediatrics

Volume 120, Issue 6, June 1992, Pages 961-965

https://doi.org/10.1016/S0022-3476(05)81971-7 Get rights and content

The effects of dexamethasone therapy on the hypothalamic-pituitary-adrenal axis were tested in 10 premature infants with bronchopulmonary dysplasia by means of the corticotropin-releasing hormone stimulation test before therapy and on the seventh day of therapy. Adrenocorticotropic hormone and cortisol levels were determined by radioimmunoassay. There was significant suppression of the hypothalamic-pituitary-adrenal axis after 7 days of a currently used dexamethasone treatment regimen. A site of suppression was located at the level of the pituitary gland.

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Cited by (50)

Inhaled Drugs and Systemic Corticosteroids for Bronchopulmonary Dysplasia
2017, Pediatric Clinics of North America
Citation Excerpt :
In higher doses, the growth was suppressed for more than 24 hours.48 Significant suppression of the hypothalamic–pituitary–adrenal axis was seen after 7 days of a dexamethasone treatment regimen.49 Hydrocortisone may have fewer or no adverse effects on neurosensory development in preterm infants and it has been the focus of recent clinical research activity.
Complications
2011, Assisted Ventilation of the Neonate
23-Complications. Diagnostic Criteria.
2010, Assisted Ventilation of the Neonate: Expert Consult - Online and Print
Repeat doses of antenatal steroids and hypothalamic-pituitary-adrenal axis (HPA) function
2007, American Journal of Obstetrics and Gynecology
Citation Excerpt :
This finding is in agreement with the only other published data from a randomized trial.30 In addition, the basal cortisol levels reported in our study were similar to those found in other preterm populations.13,23,33,34 Second, the response to metyrapone was similar in both the single- and repeated- exposure groups, suggesting no difference in the ability of the pituitary and hypothalamus to respond to challenge.
This study was undertaken to compare the effects of exposure to repeated courses of antenatal steroids with those of a single course on hypothalamic-pituitary-adrenal axis function.
Women at risk of premature delivery were assessed for entry into a randomized controlled trial of repeated courses of corticosteroids (ACTORDS). If a woman declined the randomized trial then consent was sought for collection of observational data. Baseline bloods for cortisol and adrenocorticotropic hormone levels were collected and in a subset of infants a metyrapone test performed.
In the 86 studied infants, cortisol and adrenocorticotropic hormone levels did not differ between those exposed to single and repeated courses of antenatal steroids (P = .53 and P = .15, respectively). Although cortisol levels fell in response to metyrapone (P = .03) this response was not different between the single and repeated course groups (P = .46).
Repeated courses of antenatal steroids do not cause important hypothalamic-pituitary-adrenal axis suppression in the neonate.
Adrenal suppression and extubation rate after moderately early low-dose dexamethasone therapy in very preterm infants
2003, Early Human Development
Objective: A short course of moderately early dexamethasone therapy with a starting dose of 0.5 mg/kg/day improves lung compliance and shortens the duration of ventilatory support in preterm infants with respiratory distress syndrome (RDS). We conducted a double-blind, randomized study to evaluate whether a moderately early 14-day weaning course of low-dose dexamethasone affects adrenal function and facilitates weaning from the ventilator. Patients and methods: Thirty-six preterm infants with a gestational age ≤32 weeks who required ventilatory support for RDS on days 7–14 were randomized to a 14-day treatment course with dexamethasone (0.2 mg/kg/day start, tapering doses) or placebo (equivalent amounts of normal saline). Prior to the first study treatment and the day after completion of the treatment course, adrenal function was assessed from serum cortisol levels drawn before and 30 min after intravenous administration of 0.1 mg Cortrosyn. Extubation rate during treatment in both groups was compared. Results: In both groups baseline serum cortisol levels decreased significantly during treatment, but stimulated cortisol levels did not change. After the 14-day treatment course, stimulated cortisol levels increased significantly from baseline levels in both groups (p<0.001), following Cortrosyn administration. More infants in the dexamethasone group were extubated within 7–14 days of study entry than in the placebo group (p<0.05). Hyperglycemia was more frequently diagnosed in the dexamethasone group and open-label dexamethasone treatment was given more frequently in the control group. Conclusions: A moderately early 14-day weaning course of low-dose dexamethasone does not significantly suppress the adrenal function of very preterm infants with RDS, but accelerates weaning from the ventilator.
Complications
2003, Assisted Ventilation of the Neonate

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View full text

Effects of dexamethasone on the hypothalamic-pituitary-adrenal axis in preterm infants

J Pediatr

Pediatr Clin North Am

J Pediatr

Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia

Pediatrics

Dexamethasone effects on the hospital course of infants with bronchopulmonary dysplasia who are dependent on artificial ventilation

Pediatrics

Toxic reactions and side effects of glucocorticoids in man

Am J Hosp Pharm

Pulmonary disease following respirator therapy of hyaline-membrane disease

N Engl J Med