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PS-315 Neonatal Adrenal Suppression After Maternal Corticosteroid Use? A Single-centre Case-study
  1. L de Vetten1,
  2. M van Stuijvenberg2,
  3. IP Kema3,
  4. G Bocca4
  1. 1Pediatrics, University Medical Centre Groningen, Groningen, Netherlands
  2. 2Neonatology, University Medical Centre Groningen, Groningen, Netherlands
  3. 3Clinical Chemistry, University Medical Centre Groningen, Groningen, Netherlands
  4. 4Pediatric Endocrinology, University Medical Centre Groningen, Groningen, Netherlands

Abstract

Background The use of supra-physiological exogenous corticosteroids in pregnancy can lead to neonatal adrenal suppression causing life-threatening disease. However, evidence on the occurrence of neonatal adrenal suppression after maternal steroid use, is lacking.

Objective Examining the occurrence of adrenal suppression in newborns after maternal steroid use during pregnancy.

Methods Single-centre case series including all newborns (n = 18) between October 1st, 2006 and February 1st, 2014 of mothers using prednisolone, more than 10 mg/ day. Newborns were routinely assessed by physical examination, blood glucose concentrations, serum cortisol, adrenocorticotropic hormone concentration and urinary steroid profiles within 48 h after birth. Hypoglycemia was defined as blood glucose below 2,6 mmol/L (46 mg/dl). Abnormal serum cortisol was defined as twice below 100 nmol/L. An abnormal urinary steroid profile was defined as absence of fetal metabolites.

Results Six newborns suffered from hypoglycemia, responding well to oral feedings or intravenous glucose administration. All had additional risk factors for hypoglycemia; none had abnormal serum cortisol concentrations or urinary steroid profiles. In two newborns abnormalities in urinary steroid profiles were suggestive for adrenal suppression, although both had adequate serum cortisol concentrations. In both cases, the infants were born prematurely and placenta bed pathology was suspected. After four weeks, urinary steroid profiles of both neonates showed fetal metabolites.

Conclusion No clinically relevant adrenal suppression was found in eighteen newborns of mothers using corticosteroids during pregnancy. Assessment of adrenal function should be preserved for newborns with clinical suspicion of adrenal dysfunction or with risk factors as prematurity or placenta bed pathology.

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