TY - JOUR
T1 - Corticosteroid binding globulin, total serum cortisol, and stress in extremely low-birth-weight infants
AU - Hanna, Cheryl E.
AU - Jett, Patricia L.
AU - Laird, Mary R.
AU - Mandel, Scott H.
AU - Lafranchi, Stephen H.
AU - Reynolds, John W.
PY - 1997/4
Y1 - 1997/4
N2 - Our objective was to determine if low levels of corticosteroid binding globulin (CBG) might explain the low serum total cortisol levels found in some extremely low-birth-weight (ELBW) infants. In a prospective study, serum total cortisol and CBG were measured in single blood samples from 31 ELBW infants, with a gestational age less than 28 weeks, in the first 8 days of life. Severity of illness was assessed using the Score for Neonatal Acute Physiology Perinatal Extension (SNAP-PE). The mean serum total cortisol (mean ± 1 SD) was 9.2 ± 9.8 mcg/mL and the mean CBG level was 1.4 ± 0.31 mg/dL. There was no significant correlation between serum total cortisol and CBG levels (r = 0.18), severity of illness as measured by the SNAP-PE (r = + 0.12), or birth weight (r= 0.12). Five of 31 infants, having a mean SNAP-PE score of 41, had serum total cortisol levels ≤3.0 mcg/dL. Estimated mean serum free cortisol concentrations in these five infants (0.76 mcg/dL) were comparable to estimated free cortisol levels diagnostic of adrenal insufficiency in sick adult patients. Our findings indicate that CBG levels are lower in ELBW infants than in term infants, but low CBG levels do not explain the low serum total cortisol levels found in some very sick infants. Low cortisol levels in small premature infants may be adequate to support growth if the infant is well, but may result in a syndrome of adrenal insufficiency in those with severe illnesses.
AB - Our objective was to determine if low levels of corticosteroid binding globulin (CBG) might explain the low serum total cortisol levels found in some extremely low-birth-weight (ELBW) infants. In a prospective study, serum total cortisol and CBG were measured in single blood samples from 31 ELBW infants, with a gestational age less than 28 weeks, in the first 8 days of life. Severity of illness was assessed using the Score for Neonatal Acute Physiology Perinatal Extension (SNAP-PE). The mean serum total cortisol (mean ± 1 SD) was 9.2 ± 9.8 mcg/mL and the mean CBG level was 1.4 ± 0.31 mg/dL. There was no significant correlation between serum total cortisol and CBG levels (r = 0.18), severity of illness as measured by the SNAP-PE (r = + 0.12), or birth weight (r= 0.12). Five of 31 infants, having a mean SNAP-PE score of 41, had serum total cortisol levels ≤3.0 mcg/dL. Estimated mean serum free cortisol concentrations in these five infants (0.76 mcg/dL) were comparable to estimated free cortisol levels diagnostic of adrenal insufficiency in sick adult patients. Our findings indicate that CBG levels are lower in ELBW infants than in term infants, but low CBG levels do not explain the low serum total cortisol levels found in some very sick infants. Low cortisol levels in small premature infants may be adequate to support growth if the infant is well, but may result in a syndrome of adrenal insufficiency in those with severe illnesses.
KW - Corticosteroid binding globulin
KW - adrenal insufficiency
KW - cortisol
KW - extremely low birth weight infants
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U2 - 10.1055/s-2007-994127
DO - 10.1055/s-2007-994127
M3 - Article
C2 - 9259928
AN - SCOPUS:0031003172
VL - 14
SP - 201
EP - 204
JO - American Journal of Perinatology
JF - American Journal of Perinatology
SN - 0735-1631
IS - 4
ER -