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Limited response to CRH stimulation tests at 2 weeks of age in preterm infants born at less than 30 weeks of gestational age
Author(s) -
Niwa Fusako,
Kawai Masahiko,
Kanazawa Hoshinori,
Iwanaga Kougorou,
Matsukura Takashi,
Shibata Minoru,
Hasegawa Takeshi,
Heike Toshio
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12049
Subject(s) - gestational age , medicine , stimulation , gestation , endocrinology , pregnancy , biology , genetics
Summary Background The high incidence of glucocorticoid‐responsive complications in extremely preterm infants suggests the immaturity of their adrenal function; however, knowledge of the hypothalamus–pituitary–adrenal ( 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 (37–41 weeks of postmenstrual age) for 21 VLBW infants with a gestational age ( GA ) <30 weeks at birth. Results Basal cortisol values at 2 weeks of age were significantly higher than those at term in VLBW infants < 30 weeks of gestation at birth (304·1 ± 146·3 nmol/l vs 184·7 ± 108·2 nmol/l). Response to corticotropin‐releasing hormone ( CRH ) stimulation tests at 2 weeks of age was significantly lower than at term (delta cortisol 148·3 ± 90·7 nmol/l vs 271·8 ± 167·0 nmol/l, delta ACTH 3·9 ± 3·2 pmol/l vs 12·3 ± 9·2 pmol/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.