Description of suspected adrenal insufficiency in the premature infant

The purpose of this study is to describe the signs and symptoms of suspected adrenal insufficiency in the extremely premature infant. Fifteen extremely premature infants (EPI) tested with adrenocorticotropic hormone (ACTH) and treated with hydrocortisone (HCTC) were reviewed to describe physiological differences prior to and post treatment with HCTC. Demographic variables were similar among infants. Baseline serum cortisol levels were less than reported normative values in 7 of 15 infants and response to ACTH was noted as adequate in 5 out of 15 infants. Statistically significant differences in pre and post serum potassium levels could not be supported due to outlying variables. A total of 7 infants had oliguria at the time of diagnosis; 3 resolved post ACTH testing and 4 resolved post HCTC. The latter 4 infants had a significant increase in urine output only after HCTC and despite previous hours of dopamine treatment. Systolic blood pressures (SBP's) rose significantly post HCTC. Mean Air-way pressure (MAP) and percent of inspired oxygen (Fio2) showed a significant improvement in all 15 infants, including 3 who were extubated and on nasal canula by 8 days post HCTC. The findings of this retrospective study are purely descriptive and in no way meant to promote the use of steroids among extremely premature infants. The description of findings may, however, promote future research as to the potential of adrenal insufficiency in this population.