Effect of multiple courses of antenatal corticosteroids on pituitary-adrenal function in preterm infants
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.
METHODSThe
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.
RESULTSThe 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).
CONCLUSIONSThe
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:
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Ng, P. C.
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Spencer, C., Neales, K.
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