EC Paediatrics

Introduction: Neonatal sepsis is one of the most common causes of neonatal morbidity and mortality. The prevalence of adrenal insufficiency in neonatal septic shock is not known. Measurement of serum cortisol levels helps in the identification of adrenal insufficiency and its prompt management may decrease mortality due to adrenal insufficiency.

Objective: To assess the proportion of adrenal insufficiency in neonatal septic shock.

Methods: It is a hospital-based, case series study conducted over 15 months. A total of 35 neonates with septic shock and inotrope support were included and neonates on immune suppressants were excluded. Total serum cortisol levels at the onset of septic shock were measured. Adrenal insufficiency was considered absolute and relative if total serum cortisol levels were less than 6 ug/dl, and 7 to 15 ug/dl respectively.

Results: 8 (22.8%) neonates had absolute adrenal insufficiency, 9 (25.71%) neonates had relative adrenal insufficiency, 7 (20%) neonates had normal cortisol levels, and 31 (45.7%) neonates had high serum cortisol levels. 8 Neonates with absolute adrenal insufficiency were given injections of hydrocortisone (1 mg/kg/dose), 7 of them showed clinical improvement in septic shock, and one baby died.

Conclusion: Hydrocortisone improved the outcome in neonatal septic shock with adrenal insufficiency. Hence early estimation of cortisol levels and early administration of stress dose of hydrocortisone in adrenal insufficiency in septic shock neonates helps in reducing the mortality.

Keywords: Adrenal Insufficiency; Cortisol; Hydrocortisone; Neonates; Septic Shock

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