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Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones.
- Source :
-
The Journal of pediatrics [J Pediatr] 2014 Jun; Vol. 164 (6), pp. 1449-55.e1. Date of Electronic Publication: 2014 Mar 15. - Publication Year :
- 2014
-
Abstract
- Objective: To test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation.<br />Study Design: We performed a multicenter study of infants born at <32 weeks' gestation who were about to undergo PDA ligation. Serum adrenal steroids were measured 3 times: before and after a cosyntropin (1.0 μg/kg) stimulation test (performed before the ligation), and at 10-12 hours after the ligation. A standardized approach for diagnosis and treatment of postoperative hypotension was followed at each site. A modified inotrope score (1 × dopamine [μg/kg/min] + 1 × dobutamine) was used to monitor the catecholamine support an infant received. Infants were considered to have catecholamine-resistant hypotension if their greatest inotrope score was >15.<br />Results: Of 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.<br />Conclusion: Infants 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.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Adrenocorticotropic Hormone metabolism
Cardiac Surgical Procedures methods
Cohort Studies
Drug Resistance
Ductus Arteriosus, Patent diagnosis
Ductus Arteriosus, Patent mortality
Female
Follow-Up Studies
Humans
Hypotension drug therapy
Hypotension physiopathology
Infant, Newborn
Ligation adverse effects
Ligation methods
Male
Postoperative Care methods
Postoperative Complications diagnosis
Postoperative Complications drug therapy
Preoperative Care methods
Retrospective Studies
Risk Assessment
Survival Rate
Cardiac Surgical Procedures adverse effects
Catecholamines administration & dosage
Ductus Arteriosus, Patent surgery
Hydrocortisone blood
Hypotension etiology
Infant, Premature
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6833
- Volume :
- 164
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 24636853
- Full Text :
- https://doi.org/10.1016/j.jpeds.2014.01.058