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J Perinatol. 2019 Mar 12. doi: 10.1038/s41372-019-0344-7. [Epub ahead of print]

Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids.

Author information

1
Division of Neonatal-Perinatal, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA.
2
Division of Neonatal-Perinatal, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA. charles.rosenfeld@utsouthwestern.edu.
3
Department of Internal Medicine, University of Texas Southwestern Medical School, Dallax, TX, USA and Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA.
4
Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA.

Abstract

OBJECTIVES:

Determine incidence of preoperative adrenal insufficiency in neonates >35 weeks gestation with congenital heart disease undergoing cardiothoracic surgery with bypass and effects of prophylactic methylprednisolone on postoperative hypothalamic-pituitary-adrenal function and hemodynamic stability.

DESIGN:

Prospective observational study in 36 neonates with preoperative adrenocorticotrophic hormone stimulation tests and serial total cortisol and adrenocorticotrophic hormone measurements before and after surgery. Data analyses: analysis of variance and regression.

RESULTS:

Baseline circulating adrenocorticotrophic hormone and cortisol were unchanged 4-20 days postnatal (P > 0.1); however, cortisol levels rose with increasing adrenocorticotrophic hormone, P = 0.02. Ten neonates (29%) demonstrated preoperative adrenal insufficiency (∆cortisol ≤9 µg/dl); one had postoperative hemodynamic instability. Growth-restricted neonates had lower baseline cortisol, but normal stimulation tests and responded well to surgical stresses. Seventy-five percent of neonates receiving perioperative methylprednisolone demonstrated postoperative hypothalamic-pituitary-adrenal inhibition.

CONCLUSION:

Adrenal insufficiency appears common in neonates >35 weeks gestation with congenital heart disease, but did not contribute to postoperative hemodynamic instability despite hypothalamic-pituitary-adrenal inhibition.

PMID:
30867544
DOI:
10.1038/s41372-019-0344-7

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