1. Hypotension following Patent Ductus Arteriosus Ligation: The Role of Adrenal Hormones
- Author
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Clyman, Ronald I, Wickremasinghe, Andrea, Merritt, T Allen, Solomon, Tabitha, McNamara, Patrick, Jain, Amish, Singh, Jaideep, Chu, Alison, Noori, Shahab, Sekar, Krishnamurthy, Lavoie, Pascal M, Attridge, Joshua T, Swanson, Jonathan R, Gillam-Krakauer, Maria, Reese, Jeff, DeMauro, Sara, Poindexter, Brenda, Aucott, Sue, Satpute, Monique, Fernandez, Erika, Auchus, Richard J, and Investigators, Patent Ductus Arteriosus Ligation Hypotension Trial
- Subjects
Paediatrics ,Biomedical and Clinical Sciences ,Pediatric ,Neurosciences ,Cardiovascular ,Rare Diseases ,Clinical Research ,2.1 Biological and endogenous factors ,Aetiology ,Adrenocorticotropic Hormone ,Cardiac Surgical Procedures ,Catecholamines ,Cohort Studies ,Drug Resistance ,Ductus Arteriosus ,Patent ,Female ,Follow-Up Studies ,Humans ,Hydrocortisone ,Hypotension ,Infant ,Newborn ,Infant ,Premature ,Ligation ,Male ,Postoperative Care ,Postoperative Complications ,Preoperative Care ,Retrospective Studies ,Risk Assessment ,Survival Rate ,Patent Ductus Arteriosus Ligation/Hypotension Trial Investigators ,Human Movement and Sports Sciences ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveTo test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation.Study designWe performed a multicenter study of infants born at 15.ResultsOf 95 infants enrolled, 43 (45%) developed hypotension and 14 (15%) developed catecholamine-resistant hypotension. Low postoperative cortisol levels were not associated with the overall incidence of hypotension after ligation. However, low cortisol levels were associated with the refractoriness of the hypotension to catecholamine treatment. In a multivariate analysis: the OR for developing catecholamine-resistant hypotension was OR 36.6, 95% CI 2.8-476, P = .006. Low cortisol levels (in infants with catecholamine-resistant hypotension) were not attributable to adrenal immaturity or impairment; their cortisol precursor concentrations were either low or unchanged, and their response to cosyntropin was similar to infants without catecholamine-resistant hypotension.ConclusionInfants with low cortisol concentrations after PDA ligation are likely to develop postoperative catecholamine-resistant hypotension. We speculate that decreased adrenal stimulation, rather than an impaired adrenal response to stimulation, may account for the decreased production.
- Published
- 2014