Antenatal Glucocorticoids Reduce the Incidence of Refractory Hypotension in Low Birthweight Infants during the Early Neonatal Period, but Do Not Affect It beyond This Time

Abstract

Objective This study aimed to clarify the effect of antenatal glucocorticoids (AGs) on the incidence of refractory hypotension (RH) in very low birthweight (VLBW) infants after the first week of life.

Study Design We included VLBW infants born at a gestational age of <30 weeks and divided them into three groups: the complete group (born within 7 days of completing a single course [two doses] of AGs), the incomplete group (born without complete course), and the late delivery group (born at ≥8 days after a single course). We compared the incidence and period of onset of RH among the three groups.

Results A total of 115 infants were enrolled. The incidence of RH in the first week of life was significantly lower in the complete group than in the other groups. However, there was no significant difference in the incidence of RH after the first week of life among the groups.

Conclusion AGs contribute to circulatory stabilization during the first week of life, but this effect does not last after 1 or 2 weeks of administration. In infants who receive AGs, physicians should consider that the risk of RH after the first week of life is not low.

Keywords

adrenal insufficiency - betamethasone - blood pressure - hypothalamic–pituitary–adrenal axis - preterm

Publication History

Received: 10 June 2019

Accepted: 06 January 2020

Article published online:
18 February 2020

• References

• 1 Ng PC, Lam CW, Fok TF. et al. Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed 2001; 84 (02) F122-F124
• 2 Helbock HJ, Insoft RM, Conte FA. Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics 1993; 92 (05) 715-717
• 3 Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001; 107 (05) 1070-1074
• 4 Watterberg KL. Adrenal insufficiency and cardiac dysfunction in the preterm infant. Pediatr Res 2002; 51 (04) 422-424
• 5 Seri I. Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week. J Perinatol 2006; 26 (Suppl. 01) S8-S13 , discussion S22–S23
• 6 Murphy DJ, Hope PL, Johnson A. Neonatal risk factors for cerebral palsy in very preterm babies: case-control study. BMJ 1997; 314 (7078): 404-408
• 7 Low JA, Froese AB, Galbraith RS, Smith JT, Sauerbrei EE, Derrick EJ. The association between preterm newborn hypotension and hypoxemia and outcome during the first year. Acta Paediatr 1993; 82 (05) 433-437
• 8 Fukuda S, Mizuno K, Kakita H. et al. Late circulatory dysfunction and decreased cerebral blood flow volume in infants with periventricular leukomalacia. Brain Dev 2008; 30 (09) 589-594
• 9 Kobayashi S, Fujimoto S, Koyama N. et al. Late-onset circulatory dysfunction of premature infants and late-onset periventricular leukomalacia. Pediatr Int 2008; 50 (02) 225-231
• 10 Ng PC. Adrenocortical insufficiency and refractory hypotension in preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101 (06) F571-F576
• 11 Fernandez EF, Watterberg KL. Relative adrenal insufficiency in the preterm and term infant. J Perinatol 2009; 29 (Suppl. 02) S44-S49
• 12 Kawai M. Late-onset circulatory collapse of prematurity. Pediatr Int (Roma) 2017; 59 (04) 391-396
• 13 Hanna CE, Keith LD, Colasurdo MA. et al. Hypothalamic pituitary adrenal function in the extremely low birth weight infant. J Clin Endocrinol Metab 1993; 76 (02) 384-387
• 14 Ng PC, Lee CH, Lam CW. et al. Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2004; 89 (02) F119-F126
• 15 Ng PC, Lam CW, Lee CH. et al. Reference ranges and factors affecting the human corticotropin-releasing hormone test in preterm, very low birth weight infants. J Clin Endocrinol Metab 2002; 87 (10) 4621-4628
• 16 Ng PC, Wong GW, Lam CW. et al. The pituitary-adrenal responses to exogenous human corticotropin-releasing hormone in preterm, very low birth weight infants. J Clin Endocrinol Metab 1997; 82 (03) 797-799
• 17 Kusuda S, Fujimura M, Sakuma I. et al; Neonatal Research Network, Japan. Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics 2006; 118 (04) e1130-e1138
• 18 Kawai M, Kusuda S, Cho K. et al. Nationwide surveillance of circulatory collapse associated with levothyroxine administration in very-low-birthweight infants in Japan. Pediatr Int 2012; 54 (02) 177-181
• 19 Masumoto K, Kusuda S, Aoyagi H. et al. Comparison of serum cortisol concentrations in preterm infants with or without late-onset circulatory collapse due to adrenal insufficiency of prematurity. Pediatr Res 2008; 63 (06) 686-690
• 20 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454
• 21 Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50 (04) 515-525
• 22 Bauer CR, Morrison JC, Poole WK. et al. A decreased incidence of necrotizing enterocolitis after prenatal glucocorticoid therapy. Pediatrics 1984; 73 (05) 682-688
• 23 Davis EP, Townsend EL, Gunnar MR. et al. Antenatal betamethasone treatment has a persisting influence on infant HPA axis regulation. J Perinatol 2006; 26 (03) 147-153
• 24 Niwa F, Kawai M, Kanazawa H. et al. Limited response to CRH stimulation tests at 2 weeks of age in preterm infants born at less than 30 weeks of gestational age. Clin Endocrinol (Oxf) 2013; 78 (05) 724-729
• 25 Ng PC, Wong GW, Lam CW. et al. Pituitary-adrenal response in preterm very low birth weight infants after treatment with antenatal corticosteroids. J Clin Endocrinol Metab 1997; 82 (11) 3548-3552
• 26 Thorp JA, Jones AM, Hunt C, Clark R. The effect of multidose antenatal betamethasone on maternal and infant outcomes. Am J Obstet Gynecol 2001; 184 (02) 196-202
• 27 Ng PC, Wong GW, Lam CW. et al. Effect of multiple courses of antenatal corticosteroids on pituitary-adrenal function in preterm infants. Arch Dis Child Fetal Neonatal Ed 1999; 80 (03) F213-F216
• 28 Moïse AA, Wearden ME, Kozinetz CA, Gest AL, Welty SE, Hansen TN. Antenatal steroids are associated with less need for blood pressure support in extremely premature infants. Pediatrics 1995; 95 (06) 845-850
• 29 Verma RP, Dasnadi S, Zhao Y, Chen HH. A comparative analysis of ante- and postnatal clinical characteristics of extremely premature neonates suffering from refractory and non-refractory hypotension: Is early clinical differentiation possible?. Early Hum Dev 2017; 113: 49-54
• 30 Gilstrap LC, Christensen R, Clewell WH. et al; NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273 (05) 413-418
• 31 Koyama N, Kouwaki M, Tanaka T. et al. Clinical features of late-onset circulatory dysfunction in premature infants. Res Rep Neonatol 2014; 4: 139-145