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Research Article Open access CC BY 4.0

Relative Adrenal Insufficiency in Full-Term and Preterm Neonates with Neonatal Sepsis

Reem Mohamed Elsheikh, Abdelrahman Mohamed Elmashad, Amany Mohamed Aboelenin, Shymaa Mohamed Elrifaey

Asian Journal of Pediatric Research · pp. 1–13 · Published 3 Jan 2024

10.9734/ajpr/2024/v14i1314

Abstract

Background: Neonatal sepsis is the third most common cause of death in newborns and a significant issue for public health, particularly in developing nations. This study aimed to assess the hypothalamic-pituitary-adrenal axis (HPA) response in full-term and preterm newborns diagnosed with neonatal sepsis in the neonatal intensive care unit (NICU). Methods: This cross-section observational research was done on neonates who were categorized into two main groups Group I: Sepsis neonates who were further subdivided into two groups according to the gestational age into 30 full-term neonates with neonatal sepsis and 30 preterm neonates with neonatal sepsis. Group II: Included 30 healthy control neonates. Results: HSS score and C reactive protein (CRP) level were correlated with serum cortisol level at (9 am: r=-0.273, P<0.035 and r=-0.447, P<0.001), (9 pm: r=-0.447, P<0.001and r=-0.477, P<0.001) ACTH at (9 am: r=-0.314, P<0.015 and r=-0.377, P<0.003) and at (9 pm: r= -0.362, P<0.005 and r=-0.448, P<0.001)  and cortisol level post ACTH stimulation (r=-0.345, 0.007 and r=-0.497, P<0.001) respectively. Regarding inotropes, sepsis type and oxygen support there was significant difference between both groups. Conclusions: 75% of the patients we evaluated with neonatal sepsis had relative adrenal insufficiency (RAI). ACTH and Cortisol values were correlated to CRP and HSS score as an inflammatory marker. This reflects suppressed HPA status in this critical clinical condition.

ACTH adrenal insufficiency full-term neonates preterm neonates neonatal sepsis

References (34)

  1. 1 Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock [DOI]
  2. 2 Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress [DOI]
  3. 3 The Hypothalamic–Pituitary–Adrenal Axis and Immune-Mediated Inflammation [DOI]
  4. 4 Stressor Specificity of Central Neuroendocrine Responses: Implications for Stress-Related Disorders [DOI]
  5. 5 Systemic inflammation in decompensated cirrhosis: Characterization and role in acute‐on‐chronic liver failure [DOI]
  6. 6 Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis [DOI]
  7. 7 Neuroendocrine aspects of the response to stress [DOI]
  8. 8 NEUROENDOCRINOLOGY OF STRESS [DOI]
  9. 9 Role of glucocorticoid negative feedback in the regulation of HPA axis pulsatility [DOI]
  10. 10 Challenges in the diagnosis and management of neonatal sepsis [DOI]
  11. 11 Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock [DOI]
  12. 12 Absolute and relative adrenal insufficiency in children with septic shock* [DOI]
  13. 13 Laboratory Tests and Diagnostic Procedures
  14. 14 Adrenocortical dysfunction in liver disease: A systematic review [DOI]
  15. 15 Steroids in the Treatment of Clinical Septic Shock [DOI]
  16. 16 Adrenal insufficiency during septic shock* [DOI]
  17. 17 Effect of Gestational Age, Postnatal Age, and Illness on Plasma Cortisol Concentrations in Premature Infants [DOI]
  18. 18 Cortisol levels and mortality in severe sepsis [DOI]
  19. 19 Evaluation of Random Plasma Cortisol and the Low Dose Corticotropin Test as Indicators of Adrenal Secretory Capacity in Critically Ill Patients: A Prospective Study [DOI]
  20. 20 Impaired cortisol response to acute stressors in patients with coronary disease. Implications for inflammatory activity [DOI]
  21. 21 ACTH and cortisol response to critical illness in term and late preterm newborns [DOI]
  22. 22 Prevalence of Low Cortisol Values in Term and Near-Term Infants with Vasopressor-Resistant Hypotension [DOI]
  23. 23 Analytical and clinical aspects of adrenocorticotrophin determination [DOI]
  24. 24 Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns [DOI]
  25. 25 Hypotension following Patent Ductus Arteriosus Ligation: The Role of Adrenal Hormones [DOI]
  26. 26 Macrophage Migration Inhibitory Factor and Hypothalamo-Pituitary-Adrenal Function during Critical Illness [DOI]
  27. 27 Serum cortisol and thyroid hormone levels in neonates with sepsis [DOI]
  28. 28 Adrenal Dysfunction in Critically Ill Patients [DOI]
  29. 29 Low Serum Cortisol in Term Newborns With Refractory Hypotension [DOI]
  30. 30 On the Diagnosis of Adrenal Insufficiency in Severe Sepsis and Septic Shock [DOI]
  31. 31 Macrophage Migration Inhibitory Factor and Hypothalamo-Pituitary-Adrenal Function during Critical Illness [DOI]
  32. 32 Retrospective review of Synacthen testing in infants [DOI]
  33. 33 Basic Haematological Scoring System-Is it the most Accurate Neonatal Sepsis Predictor? [DOI]
  34. 34 Current Emergency and Hospital Medicine Reports [DOI]

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