1087 Significance of Serum Cortisol in Preterm Infants with Refractory Hypotension

Background: A significant proportion of sick preterm infants suffer from systemic hypotension that is resistant to volume expansion and inotrope treatment. These infants respond readily to corticosteroids indicating a state of adrenocortical insufficiency. Aim: Our aim was to look at serum cortisol level in sick preterm infants and any correlation between this level and the need for hydrocortisone therapy for refractory hypotension. Method: A retrospective study looking at serum cortisol levels, taken before starting hydrocortisone therapy in ill preterm infants with refractory hypotension over one year period. Reference range for serum cortisol level in well preterm infants: 73- 562 nmol/l. Hydrocortisone dose schedule was 2.5 mg/kg/dose given 6 hourly. Hydrocortisone was stopped at the earliest opportunity. Result: Out of total 21 episodes, 4 episodes were excluded as they were repeat episodes in two infants. 17 preterm infants were included in the study (birth weight range 530gms -1224gms and corrected gestation range 25wks - 31wks 6 days). Range of serum cortisol level was between 153- 415 nmol/l. Hydrocortisone needed for these infants varied from 1dose to 32 doses. There was no positive correlation noted between the cortisol level and need for hydrocortisone therapy. No relationship was noted between corrected gestational age and serum cortisol level. Conclusion: Although sick preterm neonates had serum cortisol levels which were ‘normal’ for well preterm infants, this probably reflects a failure to respond to stress and relative inadequacy of cortisol production. Serum cortisol levels did not reflect the degree of need for hydrocortisone therapy in sick preterm infants.