Serum cortisol levels in asphyxiated infants with hypotension.

Abstract Background Hemodynamic instability due to cardiovascular insufficiency is a common complication in asphyxiated, cooled neonates. Hypotension is often resistant to volume and catecholamine administration, which could be related to low serum cortisol values. Relative adrenal insufficiency (RAI) has not been studied in detail in critically ill, hypotensive neonates with perinatal asphyxia between the 0 and 168th postnatal hours (during and immediately after hypothermia treatment). Aims To assess serum cortisol values in asphyxiated, hypotensive infants treated with hypothermia and examine the relationship between serum cortisol values and severity of illness. Methods We conducted a retrospective cohort study between 2007 and 2016, including term neonates with moderate-to-severe hypoxic-ischemic encephalopathy who underwent standard hypothermia treatment. Cortisol values were measured in 79 infants whenever hypotension occurred in the first week of life. Results Serum cortisol values displayed an exponential decay characteristic after birth with 89% of the measurements being p  = 0.002). Eventually 57% of patients received low-dose hydrocortisone supplementation (HCS) at a median dose of 0.6 [0.5; 1.0] mg/kg due to hemodynamic instability and suspected RAI. Among those who were available for follow-up, patients with or without HCS scored similarly on the Bayley-II. Conclusions Our results suggest that asphyxiated, cooled infants presenting with hypotension were likely to have low serum cortisol values. Further studies are needed to test the efficacy and long-term safety of hydrocortisone administration in the treatment of hypotension in asphyxiated, cooled neonates.