Adrenal Function In Noeonates With Sepsis

Objective To observe the adrenal function in neonates with sepsis, the incidence of adrenal insufficiency in neonates with sepsis, and explore the relationships between adrenal function and severity of sepsis.Method 80 neonates (gestational age≥36w) were selected from shanghai children hospital, these neonates were divided into 2 group consisting of 20 neonates ( as control group) and 60 neonates with sepsis (as experimental group) respectively. 60 neonates with sepsis were subdivided into 2 group according to whether they are severe sepsis , severe sepsis (SS) group consisted of 11 neonates and sepsis (S) group consisted of 49 neonates. The venous blood samples were collected and 30 minutes after low-dose ACTH stimulation test respectively. The serum cortisol levels were measured by chemiluminescence immunoassay.Results 1. Control group: the mean basal serum cortisol level was 10.62ug/dl (95%CI 7.91~13.34ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 31.51ug/dl (95%CI 27.88~35.14ug/dl); experimental group: the mean basal serum cortisol level was 31.64ug/dl (95%CI 25.29~36.93ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 47.63ug/dl (95%CI 42.56~52.71ug/dl); The mean basal serum cortisol level of experimental group was significantly higher than that of the control group (P=0.0001<0.01), The mean peak serum cortisol level of the experimental group was significantly higher than that of the control group (P=0.0001<0.01). 2. S group: the mean basal serum cortisol level was 23.24ug/dl (95%CI 18.22~28.27ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 42.04ug/dl (95%CI 37.36~46.73ug/dl); SS group: the mean basal serum cortisol level was 51.89ug/dl (95%CI 33.26~70.51ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 60.36ug/dl (95%CI 45.60~75.12ug/dl); The mean basal serum cortisol level of SS group was significantly higher than that of the S group (P=0.0021<0.01), The mean peak serum cortisol level of the SS group was significantly higher than that of the S group (P=0.0026<0.01). 3. Basal serum cortisol level<15ug/dl, or peak serum cortisol level after low-dose ACTH test <17ug/dl were used to define adrenal insufficiency, and was observed in 18 of the 60 neonates with sepsis. The mean basal serum cortisol level of the neonates with adrenal insufficiency was 7.69ug/dl (95%CI 5.62~9.76ug/dl), their mean peak serum cortisol level after low-dose ACTH test was 31.43ug/dl (95%CI 26.35~36.51ug/dl); The mean basal serum cortisol level of the neonates with adequate adrenal response was 35.27ug/dl (95%CI 29.29~41.26ug/dl), their mean peak serum cortisol level after low-dose ACTH test was 50.16ug/dl (95%CI 44.53~55.79 ug/dl); The mean basal serum cortisol level of the neonates with adequate adrenal response was significantly higher than that of the neonates with adrenal insufficiency (P=0.0001<0.01), the mean peak serum cortisol level of the neonates with adequate adrenal response was significantly higher than that of the neonates with adrenal insufficiency (P=0.0001<0.01). 4. None neonate died in the S group, 6 neonates died in the SS group. The mortality of the SS group was significantly higher than that of the S group (P=0.0000<0.01); 1 neonate with adrenal insufficiency and 5 neonates with adequate adrenal response died, there was no significant difference in their mortality (P=0.658>0.05).Conclusion The basal serum cortisol was significantly increased in stressed neonates with sepsis and it was positively correlated with the severity and the mortality of sepsis. The response of adrenal to stress was adequate in most neonates with sepsis, A few neonates with sepsis developed adrenal insufficiency. We found no relationship between the mortality and adrenal insufficiency.