The Function And The Relationship With Prognosis Of Adrenal Insufficiency In Critically-ill Neonates

Objective: To explore the relationship between the adrenal function and the state of illnesses in critically illneonates, including the incidence of adrenal insufficiency, and to study the the complications of neonateswith adrenal insufficiency as well as to investigate the function of adrenocorticotropic hormone (ACTH)stimulation for the prognosis of neonates with adrenal insufficiency.Methods: Eighty neonates admitted to our hospital (34weeks≤fetal age﹤42weeks and day old≤2days)were divided into three groups according to neonatal critical illness score (NCIS): non-critically ill group,moderate-critically ill group and severe-critically ill group. All the neonates enrolled had no geneticmetabolic disease and serious deformity. The blood albumin of the subjects in the study was no less than25g/l. All the neonates enrolled and their mother didn’t use corticosteroid. Then critically ill neonates weredivided into two groups based on basal cortisol: adrenal insufficiency group and adrenal normality group,the neonates with adrenal insufficiency were stimulated with a low-dose ACTH(1μg/1.73m2). Cortisol,contractive pressure, blood glucose, potassium and sodium were detected.Results: The cortisol of moderate-critically ill group (20.72±10.65) μg/dl and severe-critically ill group(21.67±8.58) μg/dl was higher than non-critically ill group (12.82±3.91) μg/dl, the difference betweenmoderate group and severe group was not significant. The incidence of adrenal insufficiency of severegroup (47％) was higher than moderate group (28％)(P<0.05). The cortisol, contractive pressure and bloodglucose of adrenal insufficiency group were lower than adrenal normality group (P<0.05); the differencesof potassium and sodium were not significant (P>0.05). The cortisol, contractive pressure and bloodglucose after ACTH stimulation were higher than before (P<0.05); the differences of potassium and sodiumwere not significant (P>0.05).Conclusions: The adrenal function was correlated with the state of illnesses, the cortisol ofmoderate-critically ill neonates heightened, but the cortisol of severe-critically ill neonates did not continueto heighten with the further development of state of illnesses; contractive pressure and blood glucosereduced in critically ill neonates with adrenal insufficiency; cortisol, contractive pressure and blood glucoseincreased significantly after low-dose ACTH stimulation, therefore low-dose ACTH stimulation hadtherapeutic action for adrenal insufficiency.