Adrenocortical response to stress in newborn infants.

Abstract

More than half of the deaths occurring under the age of 12 years take place during the first week of life, and the term 'biochemical death' is sometimes used where an adequate pathological explanation cannot be found at necropsy. Following the pioneer work of Selye (1936), which drew attention to the prominent role of the adrenal cortex in the endocrine response to stress, it became established that an increased secretion of corticosteroids occurred in adults under conditions of stress, and that, in some unknown manner, such hormonal activity was essential to the well-being and even to the survival of the subjects in such circumstances.In paediatric circles, however, it was thought that the adrenocortical response to stress might be relatively deficient in newborn infants, and Bongiovanni (1951) al., 1959;Colle et al., 1960) found that the urinary excretion of Porter-Silber chromogens by infants undergoing surgery during the first 4 days of life showed no significant increase over the excretion of these compounds in normal controls, though there was a marked increase in the excretion of 17-hydroxycorticosteroids measured in this way when infants were subjected to surgery during the second week of life. Studies of plasma corticosteroids measured as Porter-Silber chromogens by Klein, Fortunato, and Papadatos (1954) showed that the normal newborn infant from the second to the fifth

Adrenocortical Steroids in Small-for-Gestational-Age Term Infants during the Early Neonatal Period1,2

“…Again it can be speculated that postnatal adaptation in the first 12 h of life is less stressful in SGA infants or that the adrenal cortex is not able to react adequately to stress. Two earlier studies (23,24) of adrenal function in intrauterine growth-retarded infants have shown abnormal cortisol secretion rates and a decreased steroid response to stress, whereas Reynolds et al (25) reported a normal cortisol response to ACTH stimulation in intrauterine growth-retarded infants. Hypoglycemia, a frequent condition in SGA infants, can be excluded as a possible factor influencing adrenal steroid response, because normoglycemia was maintained in all infants by initial intravenous glucose followed by early oral glucose supply.…”

Stress response and its relationship to cystic (pseudofollicular) change in the definitive cortex of the adrenal gland in stillborn infants.

“…Some possible parallels may be drawn between the relative infrequency of histological stress in infants of low birthweight, and a temporary lack of a response to cold stress in infants of low birthweight (Hey and Katz, 1969) and diminished steroid production in infants of low birthweight (Cathro et al, 1969). Clearly a great deal of useful information might be gained by undertaking studies to compare endogenous steroid production in the fetus with pulmonary compliance and, in those infants who do not survive to compare adrenal histology at necropsy with pulmonary pressure or volume curves.…”

Cortisol Secretion in Stressed Babies during the Neonatal Period

“…Stress has been reported to increase serum cortisol [11] and free urinary cortisol levels [12] in preterm infants during the first 5 days of life. High corti sol values have been reported in single blood sample mea surements in neonates with perinatal asphyxia [13], RDS [12,14,15], intraventricular hemorrhage [16], patent duc tus arteriosus and pneumothorax [17],…”