ArticleJournal of perinatology : official journal of the California Perinatal Association2012
The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants.
Article in Journal of perinatology : official journal of the California Perinatal Association, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 14 citations in OpenAlex.
- Assessment of adrenal function at birth using adrenal glucocorticoid precursor to product ratios to predict short-term neonatal outcomes.Pediatric research · 2020Observational
- Association between plasma cortisol and death or vasopressor refractory hypotension in preterm neonates: a prospective, cohort study.Journal of perinatology : official journal of the California Perinatal Association · 2018Article
- Salivary Cortisol Based Early ACTH Test for Identifying Adrenal Insufficiency in Low Birth Weight Infants.Indian journal of pediatrics · 2016Article
- Diagnosis and management of pediatric adrenal insufficiency.World journal of pediatrics : WJP · 2016Review
- Adding hydrocortisone as 1st line of inotropic treatment for hypotension in very low birth weight infants: authors' reply.Indian journal of pediatrics · 2014Article
- Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones.The Journal of pediatrics · 2014Article
- Dopamine-resistant hypotension and severe retinopathy of prematurity.The Journal of pediatrics · 2013Article
- The challenge of defining relative adrenal insufficiency.Journal of perinatology : official journal of the California Perinatal Association · 2012Article
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate if in preterm newborns, an early adrenocorticotropin hormone (ACTH) test can identify possible transient adrenal insufficiency (TAI), using significant hypotension as a clinical marker. STUDY
designWe studied 40 premature newborns born 24 to 29 weeks gestational age (GA) before 8 h of life. Serum cortisol levels were obtained before and 40 min after administration of 1.0 mcg kg(-1) cosyntropin. Inotropes were used to treat hypotension based on clinical assessment following no response to fluid boluses. Functional echocardiogram was used to support the clinical diagnosis of hypotension. The accuracy of the ACTH test was evaluated using receiver operating characteristic (ROC) curve.
resultStudy patients had mean GA of 26.6 weeks and birth weight of 876 g. In all, 30% required inotropes. The area under the ROC curve for the ACTH test was 87%. Using a cutoff of an increase in cortisol below 12% from baseline had 75% sensitivity and 93% specificity for detecting hypotension. This cutoff was associated with bronchopulmonary dysplasia (8/12 vs 7/28, 95% CI: 0.1 to 0.72), but not with other morbidities or death.
conclusionAn early ACTH test using the above cutoff has high specificity for detecting hypotension, and thus, can serve as a marker for potential TAI in preterm newborns. Future studies should focus on identifying those newborns for which steroid supplementation would be most beneficial.
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