ESPE Abstracts (2014) 82 P-D-2-3-502

Retrospective Analysis of Cortisol Measurement in Neonates

Geetika Kumar, Jane McNeilly, Helen McDevitt, Faisal Ahmed, Avril Mason & Guftar Shaikh


Royal Hospital for Sick Children, Glasgow, UK


Background: The predictive value of a random cortisol measurement in the neonatal population with suspected adrenal insufficiency is unknown.

Objective and hypotheses: i) determine the indications for measuring cortisol; ii) review subsequent management; and iii) establish predictors for adrenal insufficiency.

Method: A laboratory database search identified cortisol results in babies <1 year from three neonatal units between September 2010 and May 2013. Gender, gestational age, birthweight, time of test, CRIB II score, and sodium level were investigated as potential predictive factors. A random cortisol >100 nmol/l was accepted as normal. A short Synacthen test (SST) peak cortisol >450 nmol/l indicated an adequate response.

Results: 60 infants (M40:F20) had cortisols analysed, 58 had random cortisol and two a SST directly. Indications included: prolonged postnatal steroid use (n=4), conjugated hyperbilirubinaemia (n=22), hypoglycaemia (n=24), midline defect (n=6), hyponatraemia (n=4), and ‘other’ (n=2); two patients had two risk factors. In total 86 random cortisol levels were analysed; 46 were normal (209.0 nmol/l (138.3-340.8)) and 40 were low (50.5 nmol/l (30.0–71.5)). Twenty-four SST were carried out in 20 infants; ten infants (41.7%) had suboptimal cortisol peaks. In 8/10 cases, hydrocortisone was commenced, 1/10 hydrocortisone when unwell and 1/10 no plan for unclear reasons (Table 1).

Table 1.
All-SSTPassed-SSTFailed-SST
Median (Interquartile Range (IQR))Median (IQR)Median (IQR)
Gestation (weeks)36.1 (28.6–39.0)38.2 (33.5–40.9)31.9 (27.9–36.1)
Birthweight (g)1960 (790–3215)2520 (1687–3373)1220 (520–1960)
Age (weeks)42.5 (40–44.3)44.0 (42.5–45.5)40.0 (35.8–40.3)
Weight at test (g)3080 (2120–3455)3340 (2715–3850)2175 (181–2800)
Random cortisol (nmol/l)49.0 (33.0–79.0)45.5 (32.0–67.8)43.5 (32.5–50.6)
Peak cortisol (nmol/l)574 (340.3–848.3)825 (622.5–858.5)301.5 (183.5–354.3)

Conclusion: No statistically significant predictive factors for adrenal insufficiency were found from this study. There was a trend for lower gestational age, weight at birth and at time of test, and male sex (9/10 infants), suggesting potential predictive factors. There is a need for clear guidelines for the management of sub-optimal cortisol levels in neonates.

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