Cortisol response to surgical stress in neonates

Boix-Ochoa, J; Ibáñez, V Martínez; Potau, Neus; Lloret, Jorge López

doi:10.1007/bf00176196

Cited by 8 publications

(5 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 98%

“…Boix-Oxhoa [25] showed that cortisol values and the stress response after surgery in neonates younger than 9-10 days are significantly different, but that there is no difference in adrenal response between neonates over 10 days, infants and adults. A cause of these low plasma cortisol levels could be an immature neuro-endocrine transmission system in neonates [25]. As the proportion of neonates was comparable in both groups (seven patients in group 1 and five patients in group 2), we believe that age was not an important confounder in this study.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery

Verweij

Hogenbirk

Roest

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency. METHODS:A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of <100 nmol/l and patients with a serum total cortisol of ≥100 nmol/l. RESULTS: A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (<100 nmol/l) and 30 were assigned to Group 2 (≥100 nmol/l). Haemodynamics improved after hydrocortisone administration, with an increase in blood pressure, a decrease in administered vasopressors and inotropic drugs, an increase in urine production and a decrease in plasma lactate concentrations. CONCLUSIONS:The effects of treatment with hydrocortisone in children with low cardiac output after cardiac surgery was similar in patients with a low baseline serum cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery

Verweij

Hogenbirk

Roest

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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“…Allerdings wurde bei Neugeborenen, die jünger als 9 Tage waren, ein signifikant niedrigerer postoperativer Kortisolanstieg gemessen als bei Neugeborenen, die älter als 9 Tage waren [7]. Es scheint also eine Phase verminderter adrenaler Stressreaktivität in den ersten zwei Lebenswochen zu geben.…”

Section: Nebennierenrindenfunktion Reifer Neugeborenerunclassified

Die Nebennierenrindenfunktion sehr unreifer Frühgeborener während der frühen postnatalen Phase

Heckmann

Wudy²

2001

Klin Padiatr

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In very premature infants of less than 30 weeks gestational age there is no correlation between the severity of illness and plasma cortisol concentrations. Low plasma cortisol levels were measured during critical illness with severe arterial hypotension requiring catecholamine treatment in the first two weeks of life. Thus, a relative adrenal insufficiency is suspected. The pituitary responds to CRH and the adrenal cortex to ACTH. But it is still questionable, wether the response is sufficient. Preterm infants with an impaired adrenal function in the first weeks of life seem to be at a higher risk for developing bronchopulmonary dysplasia. Steroids are effective in the treatment of arterial hypotension and bronchopulmonary dysplasia. Because of the broad spectrum of severe and long-term adverse effects, the treatment with glucocorticoids is recommended only after carefully balancing its benefits and risks.

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“…No perioperative data for neonates have been reported. Boix-Ocha et al, however, recently published a study examining the cortisol response to operative stress in neonates and the response to exogenously administered ACTH [24]. He demonstrated significant increases in cortisol levels following ACTH administration and noted that this response was similar to the cortisol increases noted in postoperative neonates, providing indirect evidence for a role of pituitary-derived ACTH in the response to operative stress by the neonate.…”

Section: Pituitaj 7 Hormonesmentioning

confidence: 99%

“…A more detailed look at adrenocortical responses was outlined in a recent article by Boix-Ocha involving a 7-year study of infants and neonates undergoing operative or chemical (ACTH administration) stress [24]. A number of significant observations were noted: (1) neonates did not have the normal adult circadian cycle of plasma cortisol levels (this difference was postulated to be secondary to neuroendocrinological immaturity); (2) the cortisol response to surgical or biochemical (ACTH) stress was agedependent, with neonates mounting a quantitatively lesser response than infants; and (3) neonates less than 9 days of age had a more rapid response yet released significantly lower amounts of cortisol following surgical stress.…”

Section: Cortisolmentioning

confidence: 99%