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Corticotrophin‐releasing hormone stimulation tests in late‐onset circulatory collapse
Author(s) -
Ueda Hiroko,
Kakita Hiroki,
Ichimura Shintaro,
Mori Mari,
Takeshita Satoru,
Goto Tatenobu,
Kondo Tomoko,
Yamada Yasumasa
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13956
Subject(s) - medicine , vasopressin , gestational age , circulatory collapse , oliguria , placebo , stimulation , circulatory system , hormone , periventricular leukomalacia , bolus (digestion) , catecholamine , hydrocortisone , blood pressure , anesthesia , cardiology , pregnancy , renal function , pathology , genetics , alternative medicine , biology
Background Late‐onset circulatory collapse ( LCC ) is the transient development of refractory hypotension and oliguria after the early neonatal period, which may cause periventricular leukomalacia ( PVL ). The aim of this study was to evaluate the endogenous cortisol response to corticotrophin‐releasing hormone ( CRH ) and determine whether it is effective for elucidating the pathology and selecting treatment in LCC . Methods This retrospective study examined infants admitted to the neonatal intensive care unit. Included were preterm (gestational age <34 weeks) infants who underwent CRH stimulation test and were treated for LCC with no obvious cause. Hydrocortisone ( HC ; 3.3–10 mg/kg) was given by bolus injection to the LCC infants. At 2 h after treatment, infants without a 20% rise in blood pressure (systolic or mean) from before treatment were defined as non‐responsive to HC , and given catecholamine and/or vasopressin. Results Sixteen infants (median gestational age, 24 weeks 3 days; birthweight, 638 g) were eligible. Six of the infants had a good response to the CRH stimulation test. HC was effective in only three CRH good‐response cases, and catecholamine and/or vasopressin was needed in the three other cases. HC was effective, however, for all CRH non‐response cases. Conclusions Although HC is the first‐choice treatment for LCC , the CRH stimulation test facilitates prompt treatment of LCC , which may prevent PVL . The present findings help elucidate the pathology and aid in the selection of treatment for infants with LCC .