[Association between serum cortisol levels and multiple organ dysfunction in neonates with perinatal asphyxia].

Abstract

Introduction: Therapy-resistant hypotension is observed in 16% of neonates with perinatal asphyxia undergoing therapeutic hypothermia. Relative adrenal insufficiency, defined by an inadequate cortisol response to stress, is a potential etiological factor. Hydrocortisone supplementation may be the causal treatment; however, optimal dosing during hypothermia remains unknown. Serum cortisol levels may serve as a useful marker for monitoring treatment, although these levels are likely influenced by multiorgan dysfunction secondary to the hypoxic injury and by the effects of hypothermia on drug metabolism. Objective: The aim of our research was to evaluate serum cortisol levels in cooled neonates with perinatal asphyxia before and during hydrocortisone supplementation, and to investigate the association between these levels and the severity of multiorgan dysfunction. Method: This retrospective cohort study included neonates with perinatal asphyxia treated with therapeutic hypothermia and hydrocortisone supplementation at the Neonatal Intensive Care Unit, Pediatric Center, Semmelweis University between January 2007 and December 2022. We assessed serum cortisol levels and parameters indicating the severity of multiorgan dysfunction. Results: Data from 44 neonates (126 cortisol samples) were analyzed. Two-thirds of the endogenous serum cortisol levels were below the diagnostic threshold for relative adrenal insufficiency (15 µg/dl), with a median of 4.6 µg/dl [IQR 2.8; 17.1]. Hydrocortisone supplementation resulted in a significant elevation in cortisol levels (median 61.2 µg/dl [30.6; 93.4], p<0.001), which continued to rise during therapy (median 77.6 µg/dl [46.1; 171.3], p = 0.002). Newborns with more severe multiorgan dysfunction had significantly higher cortisol levels before and after hydrocortisone supplementation. Discussion: In neonates undergoing therapeutic hypothermia after perinatal asphyxia, low serum cortisol levels can be increased by hydrocortisone supplementation in cases of suspected relative adrenal insufficiency. The higher cortisol levels observed in cases of severe multiorgan dysfunction may result from increased hormone secretion, as well as reduced drug metabolism and excretion. Conclusion: Optimizing hydrocortisone therapy is crucial in the management of cooled neonates with perinatal asphyxia. Prospective pharmacokinetic studies considering the severity of multiorgan dysfunction should be conducted. Orv Hetil. 2025; 166(24): 942–952.