Bibian van der Voorn

16 CHAPTER 1 TABLE 1. Summary of studies that have assessed the HPA axis in preterm infants First author [Ref.], year n Characteristics of participants Age at assessment Measurements Group Cortisol (nmol/L) ACTH (pmol/L) Other findings basal peak basal peak No stimulation test Doerr [40], 1988 20 Preterm group: 33–36 wks, healthy (n = 8) Term group: healthy (n = 12) 2, 6, 12 and 24 h, 4 and 7 days Basal cortisol, aldosterone, 17-OHP, progesterone, S, DOC, B and E Preterm Between 87±29 a at 7 days and 267±107 a at 12 h n.a. – n.a. ↑ 17-OHP, aldosterone and B during first week of life in preterm compared to term group Term Between 75±33 a at 24 h and 288±71 a at 2 h n.a. – n.a. Lee [41], 1989 38 Preterm group: 31–35 wks, sick (n = 9) and healthy (n = 13) Term group: healthy (n = 16) 2–5 days Basal cortisol, aldosterone, 17-OHP, 17-OH pregnenolone, S, 18-OH corticosterone, DHEA, DHEAS and androstenedione Preterm sick 165±25 a n.a. – n.a. ↑ 17-OHP, S and aldosterone in preterm sick compared to preterm healthy group ↑ 17-OHP, 17-OH pregnenolone and DHEAS in preterm compared to term group Preterm healthy 190±29 a n.a. – n.a. Term 171±27 a n.a. – n.a. Nykanen [101], 2010 67 23.6–33.1 wks, sick Group 1: <28 wks (n = 27) Group 2: ≥28 wks (n = 40) 0 and 4 days Basal cortisol, 17-OHP, 17-OH pregnenolone, S and DHEAS 0 days 452 (61–2,704) b n.a. – n.a. ↑ 17-OH pregnenolone and DHEAS but similar precursor ratios in group 1 compared to group 2 4 days 277 (63–1,647) b n.a. – n.a. ↑ cortisol, 17-OHP, 17-OH pregnenolone and DHEAS but similar precursor ratios in group 1 compared to group 2 ACTH test Thomas [42], 1986 52 Preterm group: 28–36 wks, sick (n = 26) and healthy (n = 15) Term group: sick (n = 11) 3–4 days Basal and ACTH-stimulated (36 μg/kg i.m.) cortisol and 17-OHP Preterm sick 537±94 a 996±136 a – n.a. ↑ peak 17-OHP in preterm sick compared to preterm healthy group ↑ basal 17-OHP in preterm compared to term group Preterm healthy 306±45 a 631±78 a – n.a. Term 372±157 a 645±101 a – n.a. Hingre [28], 1994 25 <30 wks, sick 4 days Basal and ACTH-stimulated (36 μg/kg) cortisol, 17-OHP, 17-OH pregnenolone and S – 207±24 a – – n.a. ↑ cortisol precursors and S/ cortisol ratio but similar cortisol compared to term reference Kari [102], 1996 23 <30 wks, sick 13, 21 and 30 days Basal cortisol, DHEAS, CBG and SHBG, and ACTH- stimulated (145 μg/m 2 ) cortisol Dexamethasone, 13 days g 125 c 607 c – n.a. – Placebo, 13 days 119 c 545 c – n.a. Placebo, 21 days 176 c 817 c – n.a. Placebo, 30 days 181 c 1,127 c – n.a. Korte [29], 1996 67 <32 wks, sick 2–3 days Basal and ACTH-stimulated (0.1 or 0.2 μg/kg) cortisol, ACTH, DHEA, S and CBG – <414 in 76% of cases ≥414 in 36% of cases after ACTH 0.1 μg/ kg and in 67% of cases after ACTH 0.2 μg/kg range: 0–24 n.a. ↑ S/cortisol ratio when basal cortisol <414