Features of the hormonal status at newborns in critical condition. Article

Yu. S. Aleksandrovich1, S.A. Fomin2, K.V. Pshenisnov1

1 St. Petersburg State Pediatric Medical University, Saint-Petersburg, Russia

2 Childrenʼs City hospital № 1, Saint-Petersburg, Russia

For correspondence: Konstantin V. Pshenisnov — MD, Ph.D., associate professor of anesthesiology, intensive care and emergency pediatrics postgraduate education SBEI HE Saint-Petersburg State Pediatric Medical University Ministry of Health of the Russian Federation, Saint-Petersburg, Russia; e-mail: Psh_k@mail.ru

For citation: Aleksandrovich YuS, Fomin SA, Pshenisnov KV. Features of the hormonal status at newborns in critical condition. Article. Annals of Critical Care. 2019;4:106–112.

DOI: 10.21320/1818-474X-2019-4-106-112


Abstract

Background. Changes in hormonal status are the main factors in the implementation of all mechanisms of compensation and resistance protection, which is especially relevant for newborns in critical condition.

Objectives. Study the features of hormonal status in newborns with congenital malformations in need of surgery and intensive care.

Materials and methods. 23 newborns with congenital malformations were examined, including 10 boys and 13 girls. Gestation age was 39.3 (38–40) weeks Among the congenital malformations, right-sided false diaphragm hernia (25 %), esophageal atresia with tracheopisophageal fistula (20 %), Ledd syndrome (10 %) and omphalocele (15 %) dominated. Cystic doubling of the blind intestine (5 %), Girschprung disease (5 %), ovarian cyst (15 %) and retroperitoneal lymphangioma (5 %) were also detected. The condition of children at birth was more severe, as evidenced by the low Apgar score, which at the first minute was 7.5 (6–8) and at the fifth 8.0 (7–9) points.

Results. Children with congenital malformations were found to have higher concentrations of cortisone, cortisol, aldosterone and lower 17-hydroxyprogesterone, 17-hydroxypregnenolone, DGEA and progesterone, which were statistically significant (p < 0.05). The concentration of cortisol and aldosterone was significantly higher in the first stage of the study, most likely due to the presence of stress and massive fluid therapy (p = 0.001). It was found that upon admission to the intensive care and intensive care unit, patients had sufficiently high concentrations of all steroid hormones, with the concentration of cortisol and cortisone reaching a maximum at the third stage of the study.

Conclusion. In children with congenital malformations subjected to rapid treatment and intensive care, there is an increase in the concentration of cortisol and cortisone with a simultaneous decrease in the level of their precursors, which is a marker of stress caused by the main disease and therapeutic effects.

Keywords: hormonal status, steroids, newborn, critical condition

Received: 30.07.2019

Accepted: 05.11.2019


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