Adrenal cortical function status and catecholamine resistance in newborn with septic shock / 解放军医学杂志

ABSTRACT

Objective To investigate the functional status of adrenal cortex status in newborn with septic shock, and explore the diagnostic criteria of relative adrenal insufficiency (RAI) and catecholamine resistance in shock. Methods Fifty newborns with septic shock, 28 males and 22 females, admitted into neonatal intensive care unit (NICU) of Hangzhou Second People's Hospital from Jan. 2005 to Jun. 2009, were involved in the present study. Serum cortisol levels of the newborn patients were measured with radio immunoassay at baseline and 30 and 60 minutes after-administration of a low-dose (1?g) of adrenocorticotrophic hormone (ACTH). The patients were divided into two groups by maximal cortisol increment levels normal adrenal function (NAF) group and RAI group. Some clinical factors, for example, the fluid demands on 1st day, shock duration, mortality, neonatal critical illness score (NCIS) and the incidence of catecholamine resistance shock, were observed. According to prognosis these newborn patients were then divided into two groups nonsurvivors and survivors. The serum cortisol levels were compared after ACTH test between the two groups. Results Nineteen RAI and 31 NAF were observed in the 50 cases. The fluid demands on 1st day, shock duration and mortality were higher, while NCIS was lower in RAI group than in NAF group (P