論文

査読有り 国際誌
2019年11月

Corticotrophin-releasing hormone stimulation tests in late-onset circulatory collapse.

Pediatrics international : official journal of the Japan Pediatric Society
  • Hiroko Ueda
  • ,
  • Hiroki Kakita
  • ,
  • Shintaro Ichimura
  • ,
  • Mari Mori
  • ,
  • Satoru Takeshita
  • ,
  • Tatenobu Goto
  • ,
  • Tomoko Kondo
  • ,
  • Yasumasa Yamada

61
11
開始ページ
1114
終了ページ
1119
記述言語
英語
掲載種別
DOI
10.1111/ped.13956

BACKGROUND: Late-onset circulatory collapse (LCC) is the transient development of refractory hypotension and oliguria after the early neonatal period, which may cause periventricular leukomalacia (PVL). The aim of this study was to evaluate the endogenous cortisol response to corticotrophin-releasing hormone (CRH) and determine whether it is effective for elucidating the pathology and selecting treatment in LCC. METHODS: This retrospective study examined infants admitted to the neonatal intensive care unit. Included were preterm (gestational age <34 weeks) infants who underwent CRH stimulation test and were treated for LCC with no obvious cause. Hydrocortisone (HC; 3.3-10 mg/kg) was given by bolus injection to the LCC infants. At 2 h after treatment, infants without a 20% rise in blood pressure (systolic or mean) from before treatment were defined as non-responsive to HC, and given catecholamine and/or vasopressin. RESULTS: Sixteen infants (median gestational age, 24 weeks 3 days; birthweight, 638 g) were eligible. Six of the infants had a good response to the CRH stimulation test. HC was effective in only three CRH good-response cases, and catecholamine and/or vasopressin was needed in the three other cases. HC was effective, however, for all CRH non-response cases. CONCLUSIONS: Although HC is the first-choice treatment for LCC, the CRH stimulation test facilitates prompt treatment of LCC, which may prevent PVL. The present findings help elucidate the pathology and aid in the selection of treatment for infants with LCC.

リンク情報
DOI
https://doi.org/10.1111/ped.13956
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31281996
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900133

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