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KMID : 0438520110180010082
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Journal of the Korean Society of Neonatology
2011 Volume.18 No. 1 p.82 ~ p.88
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Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants
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Choi Eun-jin
Sohn Jin-A
Lee Eun-Hee
Lee Ju-Young
Lee Hyun-ju
Chung Hye-rim
Lee Jin-a
Choi Chang-Won
Kim Ee-Kyung
Kim Han-Suk
Kim Byeong-Il
Choi Jung-Hwan
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Abstract
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Purpose: This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes.
Methods: Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively.
Results: Gestational age was 27.8±2.5 weeks and birth weight was 1,110±307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19±7 day, 30.6±2.4 weeks, 1,285±365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2±0.7 days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6±4.1 mg/dL. Mean blood pressure increased from 25.0±5.4 mmHg to 35.0±5.3 mmHg, 38.3±8.0 mmHg and 41.9±6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9±0.6 mL/kg/hr to 4.1±3.4 mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0±2.9 μg/kg/min to 8.0±2.3 μg/kg/min, and to 5.5±3.4 μg/kg/min after 24 hours. Serum sodium concentration was increased from 130±4 mEq/L to 136±4 mEq/L, serum potassium concentration was decreased from 6.1±1.1 mEq/L to 4.6±0.6 mEq/L before and 12 hours after hydrocortisone administration.
Conclusion: In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.
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KEYWORD
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Hypotension, Adrenal insufficiency, Hydrocortisone
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