Background: Adequate adrenocortical function is essential for survival of critically ill neonates. Although most of them display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic pituitary adrenal axis (HPA), yet; adrenocortical insufficiency is seen in septic shock. Objectives: Evaluate the HPA response in critically ill neonates with shock. Methods: this prospective observational Participant: a total of 60 neonates divided into 3 groups;(A) 30 critical ill neonates with septic shock on inotropic support, (B)15 patients with sepsis with no inotropic support and(C) control group(n=15). Intervention: a single diurnal ACTH reading and two readings for serum cortisol level (diurnal and nocturnal). Results: Gram negative organism was more prevalent among the patients; 53%, 63% in groups A and B respectively. Group A showed Significant statistical hypotension before vasopressor drug administration (p<0.001) as compared to both groups. Group A showed Significant statistical improvement of blood pressure after vasopressor drug administration (p<0.001) as compared to both groups B, C. Serum cortisol was significantly higher in group A(57.21+/-24.31) and B (48.01+/-18.27 ), while it was lower in group C(19.57+/-16.05 ) . A highly statistically significant rise of serum cortisol level( p=0.000) and ACTH(p=0.000) in group A when was compared to the other two groups. Conclusion: This study introduced a new pattern of serum cortisol response in neonates ranging from very high cortisol level to a near normal values; highlighting a state of glucocorticoid resistance in neonates and relative adrenal insufficiency.

中文翻译：

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早产儿与足月新生儿在重症监护环境中肾上腺反应的新见解

背景：充足的肾上腺皮质功能对于危重新生儿的生存至关重要。尽管他们中的大多数表现出血浆皮质醇浓度升高，这反映了下丘脑垂体肾上腺轴 (HPA) 的激活，但是；肾上腺皮质功能不全见于感染性休克。目的：评估休克危重新生儿的 HPA 反应。方法：本前瞻性观察参与者：共60名新生儿分为3组；（A）30名接受正性肌力支持的感染性休克危重新生儿，（B）15名未接受正性肌力支持的脓毒症患者和（C）对照组（n =15）。干预：一个昼夜ACTH读数和两个血清皮质醇水平读数（昼夜和夜间）。结果：革兰氏阴性菌在患者中更为普遍；A组和B组分别为53%、63%。与两组相比，A 组在血管加压药给药前显示出显着的统计学低血压（p<0.001）。与 B、C 组相比，A 组显示血管加压药给药后血压有显着的统计学改善（p<0.001）。 A 组（57.21+/-24.31）和 B（48.01+/-18.27）的血清皮质醇显着升高)，而在 C(19.57+/-16.05) 组中较低。与其他两组相比，A组血清皮质醇水平(p=0.000)和ACTH(p=0.000)的升高具有高度统计学意义。结论：这项研究在新生儿中引入了一种新的血清皮质醇反应模式，范围从非常高的皮质醇水平到接近正常值；强调了新生儿糖皮质激素抵抗和相对肾上腺功能不全的状态。