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Submitted on April 6, 2005
Accepted on September 6, 2005
Professor of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM. Assistant Professor of Health Evaluation Sciences, The Pennsylvania State University College of Medicine, Hershey, PA. St. Joseph Regional Medical Center, Milwaukee, WI. Associate Professor of Pediatrics, University of Colorado School of Medicine, Denver, CO. Director, Newborn Research, Children's Hospital of St. Paul, Professor of Pediatrics, University of Minnesota School of Medicine, St. Paul, MN. Director of Clinical Research, Division of Neonatology, Children's Hospital and Clinics of Minneapolis, Minneapolis, MN. Assistant Professor of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Associate Professor of Pediatrics, State University of New York at Buffalo, Buffalo, NY. Associate Professor of Pediatrics, Tufts University School of Medicine, Boston, MA. Associate Professor of Pediatrics, Chief, Pennsylvania Hospital Newborn Pediatrics, University of Pennsylvania, Philadelphia, PA. Associate Professor of Pediatrics, Virginia Commonwealth University, Richmond, VA. Nurse Manager, General Clinical Research Center, University of New Mexico School of Medicine, Albuquerque, NM
* To whom correspondence should be addressed. E-mail: kwatterberg{at}salud.unm.edu.
Context: Various cosyntropin doses are used to test adrenal function in premature infants, without consensus on appropriate dose or adequate response.
Objective: To test the cortisol response of extremely low birth weight infants to different cosyntropin doses and evaluate whether these doses differentiate between groups of infants with clinical conditions previously associated with differential response to cosyntropin.
Design: Prospective, nested study within a randomized clinical trial of low-dose hydrocortisone, 11/1/2001 - 4/30/2003.
Setting: Nine Newborn Intensive Care Units.
Patients: Infants 500 - 999 g birth weight.
Intervention: Cosyntropin, 1.0 µg/kg or 0.1 µg/kg, given between 18 - 28 days of life.
Main outcome measure: Cortisol response to cosyntropin.
Results: 276 infants were tested. Previous hydrocortisone treatment did not suppress basal or stimulated cortisol values. Cosyntropin 1.0 µg/kg, vs. 0.1 µg/kg, yielded higher cortisol values (P < 0.001) and fewer negative responses (2% vs. 21%). The higher dose, but not the lower dose, showed different responses for girls vs. boys (P = 0.02), infants receiving enteral nutrition vs. not (P < 0.001), infants exposed to chorioamnionitis vs. not (P = 0.04), and those receiving mechanical ventilation vs. not (P = 0.02), as well as a positive correlation with fetal growth (P = 0.03). A response curve for the 1.0 µg/kg dose for infants receiving enteral nutrition (proxy for clinically well infants) showed a 10th percentile of 16.96 µg/dl. Infants with responses <10th percentile had more bronchopulmonary dysplasia and longer length of stay.
Conclusions: A cosyntropin dose of 0.1 µg/kg did not differentiate between groups of infants with clinical conditions that affect response. We recommend 1.0 µg/kg cosyntropin to test adrenal function in these infants.
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