A Study of the Cortisol Levels and the Affected Factors in Pediatric Patients with Congenital Diaphragmatic Hernia
Keywords:
Congenital diaphragmatic hernia, Cortisol levels, Mean airway pressure, Oxygenation indexAbstract
Objective: Congenital diaphragmatic hernia (CDH) is one of the most serious diseases in pediatric surgery. The morbidity and mortality associated with CDH are largely due to pulmonary hypoplasia and pulmonary hypertension. Low cortisol levels may be associated with the severity of CDH. The aim of the present study was to study the cortisol levels and evaluate factors associated with cortisol levels in pediatric patients with CDH.
Materials and Methods: A retrospective study was conducted by reviewing the medical records of infants with CDH admitted to the Queen Sirikit National Institute of Child Health (QSNICH) between August 1, 2017 and December 31, 2018. The cortisol levels of these infants were recorded and evaluated to study the factors that may be associated with decreased cortisol levels. A cortisol level that was less than 15 mcg/dl was designated as lower than the normal level. The data was analyzed using the Chi-square, Student t-test, and Pearson correlation methods. A p-value of less than 0.05 was considered significant for the purposes of this study.
Results: Twenty-eight infants with CDH (14 males, 14 females) were treated at QSNICH. The ratio of patients with low cortisol levels (< 15 mcg/dl) to normal cortisol levels (> 15 mcg/dl) was 2:1 (19:9). Within both groups, 68% of the infants developed hypotension and a subsequent 70% of these hypotensive patients required additional use of hydrocortisone and inotropic drugs in order to sustain normal blood pressure. Low gestational age was associated with low cortisol levels in these infants (p = 0.044). High mean airway pressure and high oxygenation index appear to have some correlation with low cortisol levels. Survival rates between CDH patients with low and normal cortisol groups were not significantly different (73.7% vs. 77.8%; p = 0.815), and the overall survival rate of all patients was 75%.
Conclusion: Of the 28 infants with CDH, approximately two-thirds had a low cortisol level. There was an association between low cortisol levels in infants with CDH and higher mean airway pressure and oxygenation index. Hydrocortisone may be used in CDH patients with low cortisol levels and inotrope-resistant hypotension in order to sustain a normal blood pressure.
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