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Archives of Disease in Childhood - Fetal and Neonatal Edition 1999;80:F213-F216; doi:10.1136/fn.80.3.F213
Copyright © 1999 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child Fetal Neonatal Ed 1999;80:F213-F216 ( May )

Effect of multiple courses of antenatal corticosteroids on pituitary-adrenal function in preterm infants

P C Ng,a G W K Wong,a C W K Lam,b C H Lee,a T F Fok,a M Y Wong,c K C Maa

a Department of Paediatrics Prince of Wales Hospital Chinese University of Hong Kong, b Department of Chemical Pathology, c Department of Mathematics The Hong Kong University of Science and Technology

Correspondence to: Professor P C Ng Department of Paediatrics Level 6, Clinical Science Building Prince of Wales Hospital Shatin New Territories Hong Kong.

Accepted 6 November 1998

AIM---To evaluate the pituitary-adrenal function of preterm infants whose mothers received multiple courses (8 or more doses) of antenatal dexamethasone.
METHODS---The pituitary-adrenal function of 14 preterm infants whose mothers received eight or more doses of antenatal dexamethasone were assessed using the human corticotrophin releasing hormone (hCRH) stimulation test when 7 days (n = 14) and 14 days old (n = 12). During each test, blood samples were taken at 0 (baseline), 15, 30 and 60 minutes after an intravenous bolus dose of hCRH (1 µg/kg). The corresponding hormone concentrations were compared between days 7 and 14, and with various associated factors.
RESULTS---The baseline (0 min) plasma adrenocorticotrophic hormone concentration was significantly higher at day 14 than at day 7 (p = 0.036). None of the corresponding poststimulation (15, 30, and 60 min) hormone concentrations was significantly different between the two time epochs. When the association between the hormone concentrations and the number of antenatal dexamethasone doses received by the mothers was assessed, a significant negative correlation was observed in serum cortisol concentrations at 15 and 30 min on day 14 (r = -0.59, p = 0.04 and r = -0.60, p = 0.039, respectively).
CONCLUSIONS---The absence of a significant difference in poststimulation hormone concentrations between days 7 and 14 in this cohort of infants, and the similarity of their hormone responses with those of older children and adults, suggests that no severe pituitary-adrenal suppression had occurred. None the less there was evidence of mild adrenal suppression in some of the treated infants. Vigilance in monitoring blood pressure, electrolytes and signs of adrenal suppression in infants whose mothers receive multiple courses (8 or more doses) of antenatal dexamethasone is required, as some of them might have diminished adrenal reserve.


Keywords: antenatal dexamethasone; hCRH; pituitary-adrenal; preterm


© 1999 by Archives of Disease in Childhood

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This article has been cited by other articles:

  • Ng, P. C. (2008). Is There a "Normal" Range of Serum Cortisol Concentration for Preterm Infants?. Pediatrics 122: 873-875 [Full Text]  
  • Ng, P C (2000). The fetal and neonatal hypothalamic-pituitary-adrenal axis. Arch. Dis. Child. Fetal Neonatal Ed. 82: 250F-254 [Full Text]  
  • Spencer, C., Neales, K. (2000). Antenatal corticosteroids to prevent neonatal respiratory distress syndrome. BMJ 320: 325-326 [Full Text]  

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