Suppression and recovery of the neonatal hypothalamic-pituitary-adrenal axis after prolonged dexamethasone therapy☆,☆☆,★
Section snippets
Subjects
Nine VLBW infants (four girls) in the neonatal intensive care unit at the Medical University of South Carolina who required ventilator support for early chronic lung disease were recruited after their parents gave informed consent. All the infants began a standard Dex treatment course (42 days, tapering doses) as part of their respiratory treatment. 1 The infants were 19.9 ± 8.0 (mean ± SD) days old at study entry; the average gestational age was 25.7 ± 1.0 weeks, and their weights were
Basal Cortisol Values
Basal cortisol levels were higher before Dex therapy (18.61 ± 3.92 μg/dl; mean ± SEM) than after (5.77 ± 1.45 μg/dl, p < 0.01). A baseline cortisol level of 15 μg/dl was seen in seven of nine infants before Dex therapy, compared with zero of nine infants having a level of 15 μg/dl or greater in the posttreatment group (Fig. 1).
Cortisol Values after ACTH
ACTH-stimulated cortisol levels
Discussion
High-dose glucocorticoid treatment has become a part of standard neonatal respiratory management of early chronic lung disease in the absence of a complete understanding of the adverse effects of this therapy on HPA axis function. Furthermore, normal HPA axis function in the VLBW infant remains poorly defined. Amid the myriad of tests evaluating HPA axis function, little consensus regarding normal function in the newborn infant exists.
Our results demonstrate that suppression of the HPA axis
Acknowledgements
We thank the staffs of the General Clinical Research Center and Neonatal Intensive Care Unit at the Medical University of South Carolina and L. Clewell, PharmD, for their invaluable assistance.
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Cited by (0)
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Supported by grant no. MO1RR01070 from the National Institutes of Health and a Neonatology Fellows research grant from Wyeth Laboratories (Dr. Ford).
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Reprint requests: Steven M. Willi, MD, Department of Pediatrics, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425.
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0022-3476/97/$5.00 + 0 9/21/81207