PhD Scientific Days 2017

Oral Presentations: Clinical Sciences

The possible role of relative adrenal insufficiency in haemodynamic instability of asphyxiated infants

Előadó neve

Dr. Kovács, Kata, PhD

Előadó munkahelye

Semmelweis University, 1st Department of Paediatrics

Előadó telefonszáma

+3620/4969653

Előadó e-mail címe

mail.kata.kovacs@gmail.com

Az előadás címe

The possible role of relative adrenal insufficiency in haemodynamic instability of asphyxiated infants

Szerző(k) neve és munkahelye

Kata Kovács, Enikő Szakmár, Ünőke Méder, Anna Csekő, Miklós Szabó, Ágnes Jermendy
1st Department of Paediatrics, Semmelweis University, Budapest

Szekció

Oral Presentations: Clinical Sciences

Data of the presenter

Doctoral School: Clinical Medicine
Program: Prevention of Chronic Diseases in Childhood
Supervisor: Ágnes Jermendy
E-mail address: mail.kata.kovacs@gmail.com

Text of the abstract

Introduction: Birth asphyxia is a leading cause of neonatal mortality and adverse neurological sequelae. Hemodynamic instability after ischemic myocardial damage is a common problem in asphyxiated neonates. Hypotension during hypothermia treatment is often resistant to volume and catecholamine administration, which could be related to relative adrenal insufficiency (RAI). To date, the association between perinatal asphyxia and RAI has not been studied in detail.
Aims: To describe RAI in asphyxiated infants undergoing therapeutic hypothermia.
Method: In this retrospective cohort study, medical records of term, asphyxiated neonates born between 2007 and 2016 were reviewed. Patients were cared for in the NICU of the 1st Department of Paediatrics. A total number of 100 cortisol measurements between the 0-168th hours of life and clinical characteristics of 79 patients were analysed.
Results: Serum cortisol levels displayed an exponential decay characteristic after birth in the study population. In the first week of life 88% of cortisol measurements were below 15μg/dl, which is considered to be the threshold of RAI. Patients with more severe condition, as measured on the SNAP-II severity of illness score, had significantly higher cortisol levels, but still below 15μg/dl (moderate-severe 4.97[3.94;10.90]μg/dl vs mild condition 2.75[1.97;4.60]μg/dl; p=0.002). Eventually 57% of patients received low dose hydrocortisone supplementation (HCS) at a median dose of 0.56[0.48;1.00]mg/kg due to hemodynamic instability and suspected RAI. Importantly, patients receiving HCS scored similarly on the Bayley-II test of infant development at 20 months when compared to the non-HCS group.
Conclusion: Our results suggest that asphyxiated, cooled infants presenting with systemic arterial hypotension are at high risk of RAI and low dose HCS seemed to be safe in short term based on the results of neurological follow-up examinations. Further studies are needed on the efficacy and longer term safety of HCS in the treatment of hemodynamic instability in asphyxiated neonates.

Kind

Szabad

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

1249

Authors (legacy)

Kata Kovács, Enikő Szakmár, Ünőke Méder, Anna Csekő, Miklós Szabó, Ágnes Jermendy
1st Department of Paediatrics, Semmelweis University, Budapest