본문 바로가기
KERD
논문KCI 등재

조산아에서 발생하는 부신기능부전과 연관된 저혈압의 임상상

Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants

이현주|김병일|최은진|손진아|이은희|이주영|정혜림|이진아|김이경|김한석|최창원|최중환
대한신생아학회 (THE KOREAN SOCIETY OF NEONATOLOGY)|2011.05|Neonatal medicine|제18권 제1호|pp. 82-88

1

조회

0

다운로드

7

인용

0

참고문헌

키워드

HypotensionHydrocortisoneAdrenal insufficiency

초록

목적: 본 연구에서는 부신기능부전과 연관된 저혈압의 임상적 특성과 hydrocortisone 투여에 대한 치료반응을 알아보고자 하였다. 방법: 2007년 1월 1일부터 2009년 8월 31일까지 분당서울대학교병원에서 출생하여 신생아집중치료실에 입원했던 재태주령 32주 미만의 미숙아 158명 중 미숙아 부신기능부전과 연관된 저혈압이 발생하였던 12명의 환아를 대상으로 하였고 이들의 임상적 특성과 hydrocortisone 투여 전과 후의 평균혈압, 소변량, 혈청 전해질 검사 소견을 비교하였다. 결과: 환아의 재태주령은 27.8±2.5주, 출생체중은 1,110±307g이었고 부신기능부전과 연관된 저혈압이 발생한 시기는 생후19±7일, 월경 후 주령으로는 30.6±2.4주이었고 당시 체중은1,285±365 g이었다. Dopamine 투여에도 저혈압이 발생한 미숙아는 hydrocortisone을 4.0 mg/kg/day의 스트레스 용량으로 시작해 2.2±0.7일간 유지 후 감량하였으며 hydrocortisone 투여 전의 혈청 cortisol 농도는 11.6±4.1 mg/dL이었다. Hydrocortisone 투여 당시와 2, 4, 6시간 후의 평균혈압은 25.0±5.4 mmHg에서 35.0±5.3 mmHg, 38.3±8.0 mmHg 그리고41.9±6.5 mmHg 로 증가되다가 그 후로는 안정적으로 유지되었고 소변량도 hydrocortisone 투여 전에 0.9±0.6 mL/kg/hr 에서 치료 6시간 후 4.1±3.4 mL/kg/hr로 증가되었다. 치료시작당시와 12시간 후의 dopamine 용량은 11.0±2.9 μg/kg/min 에서 8.0±2.3 μg/kg/min로 감량되었고 24시간 후에는 5.5±3.4 μg/kg/min까지 감량되었다. 혈청 Na+ 농도는 hydrocortisone hydrocortisone 투여 전 130±4 mEq/L에서 투여 12시간 후 136±4mEq/L로 증가되었고 혈청 K+ 농도는 hydrocortisone 투여 전6.1±1.1 mEq/L에서 투여 12시간 후 4.6±0.6 mEq/L로 감소하였다. 결론: 미숙아에서 부신기능부전과 연관된 저혈압이 발생한경우 hydrocortisone의 투여는 신속히 혈압을 상승시키고 소변량을 증가시켰으며 전해질 농도를 정상화시켰다.

Abstract

Purpose: This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes. Methods: Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively. Results: Gestational age was 27.8±2.5 weeks and birth weight was 1,110±307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19±7 day, 30.6±2.4 weeks, 1,285±365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2±0.7days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6±4.1 mg/dL. Mean blood pressure increased from 25.0±5.4 mmHg to 35.0±5.3 mmHg, 38.3±8.0 mmHg and 41.9±6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9±0.6 mL/kg/hr to 4.1±3.4mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0±2.9 μg/kg/min to 8.0±2.3 μg/kg/min, and to 5.5±3.4 μg/kg/min after 24 hours. Serum sodium concentration was increased from 130±4 mEq/L to 136±4 mEq/L, serum potassium concentration was decreased from 6.1±1.1 mEq/L to 4.6±0.6 mEq/L before and 12 hours after hydrocortisone administration. Conclusion: In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.

참고문헌 (27)

  1. Al-Aweel I, "Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs", J Perinatol, 21, pp.272~278 (2001)
  2. Watkins AM, "Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants", Early Hum Dev, 19, pp.103~110 (1989)
  3. Goldstein RF, "Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants", Pediatrics, 95, pp.238~243 (1995)
  4. Helbock HJ, "Glucocorticoid-responsive hypotension in extremely low birth weight newborns", Pediatrics, 92, pp.715~717 (1993)
  5. Seri I, "Circulatory support of the sick preterm infant", Semin Neonatol, 6, pp.85~95 (2001)
  6. Ng PC, "Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants", Arch Dis Child Fetal Neonatal Ed, 89, pp.F119~F126 (2004)
  7. Tantivit P, "Low serum cortisol in term newborns with refractory hypotension", J Perinatol, 19, pp.352~357 (1999)
  8. Lee MM, "Serum adrenal steroid concentrations in premature infants", J Clin Endocrinol Metab, 69, pp.1133~1136 (1989)
  9. Huysman MW, "Adrenal function in sick very preterm infants", Pediatr Res, 48, pp.629~633 (2000)
  10. Watterberg KL, "Impaired glucocorticoid synthesis in premature infants developing chronic lung disease", Pediatr Res, 50, pp.190~195 (2001)
  11. Kusuda S, "Morbidity and mortality of infants with very low birth weight in Japan: center variation", Pediatrics, 118, pp.E1130~E1138 (2006)
  12. Seri I, "Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension", Pediatrics, 107, pp.1070~1074 (2001)
  13. Ng PC, "A double-blind, randomized, controlled study of a "stress dose" of hydrocortisone for rescue treatment of refractory hypotension in preterm infants", Pediatrics, 117, pp.364~375 (2006)
  14. Noori S, "Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor-treated preterm and term neonates", Pediatrics, 118, pp.1456~1466 (2006)
  15. Munro MJ, "Hypotensive extremely low birth weight infants have reduced cerebral blood flow", Pediatrics, 114, pp.1591~1596 (2004)
  16. Kluckow M, "Low systemic blood flow and pathophysiology of the preterm transitional circulation", Early Hum Dev, 81, pp.429~437 (2005)
  17. Masumoto K, "Comparison of serum cortisol concentrations in preterm infants with or without late-onset circulatory collapse due to adrenal insufficiency of prematurity", Pediatr Res, 63, pp.686~690 (2008)
  18. Bone M, "Assessment of adrenal function in the initial phase of meningococcal disease", Pediatrics, 110, pp.563~569 (2002)
  19. Cooper MS, "Adrenal insufficiency in critical illness", J Intensive Care Med, 22, pp.348~362 (2007)
  20. Sprung CL, "Hydrocortisone therapy for patients with septic shock", N Engl J Med, 358, pp.111~124 (2008)
  21. Fernandez EF, "ACTH and cortisol response to critical illness in term and late preterm newborns", J Perinatol, 28, pp.797~802 (2008)
  22. Fernandez E, "Prevalence of low cortisol values in term and near-term infants with vasopressor-resistant hypotension", J Perinatol, 25, pp.114~118 (2005)
  23. Brodde OE, "Beta-adrenoceptor regulation in the human heart: can it be monitored in circulating lymphocytes", Eur Heart J, 10(B), pp.2~10 (1989)
  24. Davies AO, "Corticosteroid-induced differential regulation of beta-adrenergic receptors in circulating human polymorphonuclear leukocytes and mononuclear leukocytes", J Clin Endocrinol Metab, 51, pp.599~605 (1980)
  25. Wehling M, "Specific, nongenomic actions of steroid hormones", Annu Rev Physiol, 59, pp.365~393 (1997)
  26. Wolff J, "Influence of hormones on the ultrastructure of capillaries", Bibl Anat, 9, pp.334~337 (1967)
  27. Watterberg KL, "Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial", Pediatrics, 114, pp.1649~1657 (2004)

이 간행물의 다른 논문 (22건)

혈액응고 기전에 대한 고찰유철주pp. 1-5신생아 혈액 응고질환: 출혈 경향을 보이는 신생아에 대한 진단적 접근김천수pp. 6-13Disorders in Hemostasis성태정pp. 14-22신생아 혈전색전증김도현pp. 23-33신생아에서의 항응고요법, 혈전용해요법 및 혈액제제 사용최창원pp. 34-41
원문 보기