Association of Serum Cortisol Levels with Respiratory Distress Syndrome and Mortality in Premature Babies
DOI:
https://doi.org/10.51273/esc23.251919Keywords:
Cortisol, Respiratory distress syndrome(RDS), Mortality,, Premature BabiesAbstract
Objective: To evaluate Trends of cortisol level and its relation with Respiratory distress syndrome and Mortality in premature babies
Materials & Methods: A descriptive cross sectional study was conducted in Neonatal unit of pediatric medicine 1 of Bahawalvictoria hospital Bahawalpur from Feb 2021 to June 2021.Premature babies (less than 36 weeks gestation by ballard scoring )admitted in Preterm ward on day 1 were enrolled after informed consent and ruling out exclusion criteria (More than 24 hour old , Who have received antenatal steroids for lung maturation, Received any treatment before admission in any other hospital, Patient having Any obvious anomaly ).Day 1 sample sent for CRP and cortisol. Data recorded regarding weight, gestational age (ballard scoring), septic risk factors. These patients were followed for development of RDS ( on X ray at 24 hour of life). Outcome was documented as expiry, discharged or LAMA. Data analyzed in SPSS 20.
Results:40 patients were enrolled as per inclusion criteria. 27 (67.5 % ) were male and 13 (32.5 %) were female. Gestational age 3 (7.5 %) had less than 28 weeks, 29-30 weeks were 6 (15 %), 31-34 weeks were 31 (77.5 %). Weight less than 1.5 kg were 23 (57.5%), 1.5 to2 kg were 15 (37.5 %), 2.1-2.5 kg were 2 (5%). Cortisol level low in 4 (10 %), normal in 6 (15 %), high in 30 (75 %).22 (55 %) discharged, 13 (32 %) expired, and 5 (12.5 %) got LAMA. Cortisol level as compared to outcome has p value 0.002. Tweleve (30 %) had RDS. Twenty two (55 %) had evidence of sepsis. 18 (45 %) had CRP more than 6. Cortisol level as compared to RDS presence has P value 0.057 and with sepsis has P value 0.007. Mean cortisol in discharged patients were 19.8, expired 14.2 and LAMA has 22.7. Mean cortisol in RDS patients were 18.3 and RDS absent had 18.3 also. Mean cortisol in Sepsis positive patients were 18.6 and sepsis absent were 18.0
Conclusion:
Mean cortisol has no significant difference in discharged and expired patients.
Keywords: Cortisol, Respiratory distress syndrome(RDS), Mortality, Premature Babies
References
Hanif A, Ashraf T, Waheed K, Sajid MR, Guler N, Pervaiz MK. Prevalence of preterm birth in Pakistan: a systematic review and meta-analysis. Annals of King Edward Medical University. 2017 Aug 17;23(2).
Khan HS, Khalil S, Akhtar P. Morbidity and Mortality Pattern of Pre-terms. Journal of Islamabad Medical & Dental College (JIMDC). 2016;5(1):77-80.
Saboute M, Kashaki M, Bordbar A, Khalessi N, Farahani Z. The incidence of respiratory distress syndrome among preterm infants admitted to neonatal intensive care unit: a retrospective study. Open Journal of Pediatrics. 2015;5(04):285.
Scott, S., Watterberg, K. Effect of Gestational Age, Postnatal Age, and Illness on Plasma Cortisol Concentrations in Premature Infants. Pediatr Res 37, 112–116 (1995).
Ng PC. The fetal and neonatal hypothalamic–pituitary–adrenal axis. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2000 May 1;82(3):F250-4.
Fernandez EF, Watterberg KL. Relative adrenal insufficiency in the preterm and term infant. Journal of Perinatology. 2009 May;29(2):S44-9.
Hallman M. The story of antenatal steroid therapy before preterm birth. Neonatology. 2015;107(4):352-7.
Baud O, Maury L, Lebail F, et al. Effect of early low-dose hydrocortisone on survival without bronchopulmonary dysplasia in extremely preterm infants (PREMILOC): a double-blind, placebo-controlled, multicentre, randomised trial. Lancet. 2016;387(10030):1827–1836.
Heckmann M, Wudy SA, Haack D, Pohlandt F. Reference range for serum cortisol in well preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1999 Nov 1;81(3):F171-4.
Bolt RJ, Van Weissenbruch MM, Popp-Snijders C, Sweep FG, Lafeber HN, Delemarre-van de Waal HA. Maturity of the adrenal cortex in very preterm infants is related to gestational age. Pediatric research. 2002 Sep;52(3):405-10.
KoripaduSeshagiri, YanamandalaVenkataHarischandra. Cortisol levels in healthy term and preterm appropriate for gestation infants. International Journal of Contemporary Medical Research 2017;4(8):1659-1664.
Reynolds JW. Serum total corticoid and cortisol levels in premature infants with respiratory distress syndrome. Pediatrics. 1973 May;51(5):884-90.
Arafa AE, ElMeneza SA, Hafeez SA. The Relation between Role of Serum Cortisol Level and Response to Various Respiratory Support Strategies among Preterm Infants. Open Journal of Pediatrics. 2020 Sep 11;10(03):504.
Gunes T, Koklu E, Ozturk MA, Koklu S, Cetin N. Evaluation of serum cortisol levels in a relatively large and mature group of ventilated and nonventilated preterm infants with respiratory distress syndrome. American journal of perinatology. 2006 Jul;23(06):335-40.
Murphy BE. Cortisol and cortisone levels in the cord blood at delivery of infants with and without the respiratory distress syndrome. American Journal of Obstetrics and Gynecology. 1974 Aug 15;119(8):1112-20.
Bekhit OE, Mohamed SA, Yousef RM, AbdelRasol HA, Khalaf NA, Salah F. Relation between baseline total serum cortisol level and outcome in pediatric intensive care unit. Scientific Reports. 2019 Apr 12;9(1):1-6.
Sari FN, Dizdar EA, Oguz SS, Andiran N, Erdeve O, Uras N, Memik R, Dilmen U. Baseline and stimulated cortisol levels in preterm infants: is there any clinical relevance?. Hormone Research in Paediatrics. 2012;77(1):12-8.
Nykänen P, Anttila E, Heinonen K, Hallman M, Voutilainen R. Early hypoadrenalism in premature infants at risk for bronchopulmonary dysplasia or death. ActaPaediatrica. 2007 Nov;96(11):1600-5.
