Adrenal Function in Noeonates with Sepsis
|School||Shanghai Jiaotong University|
|Keywords||Sepsis Newborn Cortisol Adrenal ACTH|
Objective: The purpose of this study is to clear sepsis neonatal adrenal cortex function status, the incidence of adrenal cortical dysfunction, adrenal cortical function and sepsis severity and prognosis relations. Methods: The subjects of this study to stay in our hospital neonatal newborns ≥ 36 weeks 80 cases, including 20 cases of neonatal control group, the experimental group, 60 cases of sepsis, neonatal experimental group is further divided into 49 cases of sepsis group The group of 11 patients with severe sepsis. In this study, serum basal cortisol levels and a small dose of ACTH the excitation peak cortisol levels after the test, serum cortisol levels were detected using chemiluminescence immunoassay. Results: 1, the average level of the control group, serum basal cortisol 10.62ug/dl (95% confidence interval 7.91 to 13.34ug/dl), small dose of ACTH challenge test average peak serum cortisol 31.51ug/dl (95 % confidence interval 27.88 ~ 35.14ug/dl); the average experimental serum basal cortisol 31.64ug/dl (95% confidence interval 25.29 to 36.93ug/dl), small doses of ACTH stimulate test serum cortisol peak-to-average level of 47.63ug/dl (95% confidence interval 42.56 ~ 52.71ug/dl); serum basal cortisol average of the experimental group was significantly higher than that in the control group, P = 0.0001 lt; 0.01, statistically significant, the experimental group, serum corticosterone the alcohol peak average was significantly higher than that in the control group, P = 0.0001 lt; 0.01, was statistically significant. 2, sepsis serum basal cortisol average 23.24ug/dl (95% confidence interval 18.22 to 28.27ug/dl) average peak serum cortisol after small doses of ACTH challenge test for 42.04ug / d (l95 excitation test serum corticosterone% confidence interval 37.36 ~ 46.73ug/dl); the severe sepsis serum basal cortisol average 51.89ug/dl (95% confidence interval 33.26 to 70.51ug/dl), a small dose of ACTH the the alcohol peak average 60.36ug/dl (95% confidence interval 45.60 to 75.12ug/dl); severe sepsis serum basal cortisol average significantly higher than the sepsis group, P = 0.0021 lt; 0.01, there statistically significant, severe sepsis serum cortisol peak average significantly higher than the sepsis group, P = 0.0026 lt; 0.01, statistically significant. The 3. Diagnostic criteria for the study of sepsis neonatal adrenal insufficiency: serum foundation cortisol levels lt; excitation peak serum cortisol level after the test lt 15ug/dl, or a small dose of ACTH; 17ug/dl. In this study, 60 patients with sepsis, neonatal adrenal insufficiency in 18 cases, the serum basal cortisol the average for 7.69ug/dl (95% confidence interval 5.62 to 9.76ug/dl), low-dose ACTH challenge test The average peak serum cortisol 31.43ug/dl (95% confidence interval 26.35 ~ 36.51ug/dl); normal adrenal function sepsis in neonatal serum basal cortisol average 35.27ug / d (l95% confidence interval, 29.29 ~ 41.26ug/dl), a small dose of ACTH challenge test average peak serum cortisol 50.16ug/dl (95% confidence interval 44.53 to 55.79ug/dl); adrenocortical function normally sepsis average neonatal serum basal cortisol levels were significantly higher than adrenal insufficiency, P = 0.0001 lt; 0.01, statistically significant, also significantly higher than normal adrenal function sepsis neonatal serum cortisol peak average adrenal cortical dysfunction, P = 0.0001 lt; 0.01, statistically significant. Neonatal sepsis group in this study no deaths, neonatal deaths of severe sepsis group six cases, P = 0.0000 lt; case fatality rate of 0.01, the two groups have a significant difference; adrenal cortical dysfunction, sepsis disease neonatal death cases, normal adrenal function sepsis, neonatal death five cases, P = 0.658 gt; case fatality rate of 0.05, the two groups no significant difference. Conclusion: sepsis neonatal stress increase in the synthesis and secretion of serum cortisol, and the more severe the disease, the higher the serum basal cortisol levels higher; sepsis in neonatal serum basal cortisol levels and an increased risk of death sepsis, neonatal mortality and severity of the disease was positively correlated. Most of sepsis neonatal stress response level is sufficient, also part of sepsis neonatal secondary adrenal insufficiency, the studies have not been found between sepsis neonatal mortality and adrenal insufficiency correlation.