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Steroid treatment offers no benefit in preemies, Hopkins Children's study suggests
Date:10/9/2008

hese low levels."

While surprising, the findings are not entirely counterintuitive, investigators say, because in utero babies have naturally low cortisol levels. "This may mean that, in a way, low cortisol levels are normal, and premature babies maintain them low, as they would have been in the womb," Aucott said.

Comparing the cortisol levels of 311 extremely low-birth-weight preemies immediately after birth and one week after birth, researchers found low cortisol levels did not increase the risk for adverse short-term outcomes or death. For example, bronchopulmonary dysplasia occurred in 58 percent of infants with low cortisol levels, in 58 percent of infants with midrange cortisol levels and in 62 percent of those with moderately elevated cortisol levels. Brain hemorrhages occurred in 24 percent of infants with low cortisol levels, in 36 percent of those with midrange cortisol levels and in 49 percent of those with mildly elevated cortisol levels.

Babies with moderately to severely elevated cortisol levels at birth and shortly after birth had a higher risk for life-threatening brain bleeds, dangerous gastrointestinal perforations and severe retinopathy, researchers found. Researchers have yet to pinpoint the exact mechanism leading to these dangerous spikes in cortisol, but past studies have suggested that severe pain may drive up production of this stress hormone. Regardless of the trigger, investigators say, neonatologists should aggressively monitor infants with elevated cortisol levels because of their vulnerability to hemorrhages and other life-threatening complications.

Elevated cortisol concentrations, especially values higher than 31 micrograms per deciliter of blood at 12 to 48 hours after birth, and more than 18 micrograms per deciliter at five to seven days after birth, appeared to make babies more prone to serious bleeding in the brain, although researchers caution a cause-effect relationship could not be establish
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Contact: Katerina Pesheva
epeshev1@jhmi.edu
410-516-4996
Johns Hopkins Medical Institutions
Source:Eurekalert

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