Limited response to CRH stimulation tests at 2 weeks of age in preterm infants born at less than 30weeks of gestational age

作者：Niwa Fusako^*; Kawai Masahiko; Kanazawa Hoshinori; Iwanaga Kougorou; Matsukura Takashi; Shibata Minoru; Hasegawa Takeshi; Heike Toshio

来源：Clinical Endocrinology, 2013, 78(5): 724-729.

DOI：10.1111/cen.12049

Background The high incidence of glucocorticoid-responsive complications in extremely preterm infants suggests the immaturity of their adrenal function; however, knowledge of the hypothalamuspituitaryadrenal (HPA) axis in extremely preterm infants is limited. Methods To clarify the characteristics of the HPA axis in preterm very low birthweight (VLBW) infants, we performed CRH tests repeatedly: at about 2 weeks of age and at term (3741weeks of postmenstrual age) for 21 VLBW infants with a gestational age (GA) <30weeks at birth. Results Basal cortisol values at 2 weeks of age were significantly higher than those at term in VLBW infants<30weeks of gestation at birth (304 center dot 1 +/- 146 center dot 3nmol/l vs 184 center dot 7 +/- 108 center dot 2nmol/l). Response to corticotropin-releasing hormone (CRH) stimulation tests at 2 weeks of age was significantly lower than at term (delta cortisol 148 center dot 3 +/- 90 center dot 7nmol/l vs 271 center dot 8 +/- 167 center dot 0nmol/l, delta ACTH 3 center dot 9 +/- 3 center dot 2pmol/l vs 12 center dot 3 +/- 9 center dot 2pmol/l, respectively). We found that earlier GA contributed to the higher basal cortisol values, and antenatal glucocorticoid (AG) contributed to the lower response of cortisol to CRH tests at 2 weeks of age. Conclusions VLBW infants showed a characteristic pattern in the HPA axis at 2 weeks of age: higher basal cortisol values and lower response to CRH tests. This study suggested that AG was related to the lower response to CRH tests, at least partly.

• 出版日期2013-5