University of Oulu

This is the peer reviewed version of the following article: Khashana, A., Ojaniemi, M., Leskinen, M., Saarela, T. and Hallman, M. (2016), Term neonates with infection and shock display high cortisol precursors despite low levels of normal cortisol. Acta Paediatr, 105: 154–158., which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Term neonates with infection and shock display high cortisol precursors despite low levels of normal cortisol

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Author: Khashana, Abdelmoneim1,2; Ojaniemi, Marja1,3; Ojaniemi, Markku3;
Organizations: 1PEDEGO Research Center, and Medical Research Center Oulu, University of Oulu, Oulu, Finland
2Department of Paediatrics and Neonatology, Suez Canal University Hospital, Ismailia, Egypt
3Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: John Wiley & Sons, 2016
Publish Date: 2017-02-06


Aim: Neonatal therapy-resistant septic shock is a common problem in middle and low-income countries. We investigated whether newborn infants with infection and therapy-resistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors.

Methods: A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution. Serum was obtained during days four and 14 after birth. Cortisol and cortisol precursor concentrations were analysed using liquid chromatography-tandem mass spectrometry.

Results: The cortisol concentrations were low considering the expected responses to stress and they did not differ between the groups. The infants with infection and shock had higher serum dehydroepiandrosterone (DHEA) levels than those without shock (319.0 ± 110.3 μg/dL, versus 22.3 ± 18.3 μg/dL; p < 0.0001) and they also had higher 17-hydroxy-pregnenolone, pregnenolone and progesterone concentrations. There were no detectable differences in the levels of 17-hydroxy-progesterone, 11-deoxy-cortisol, cortisol or cortisone.

Conclusion: Septic newborn infants with therapy-resistant hypotension had very high DHEA levels, suggesting that 3-beta-hydroxysteroid dehydrogenase activity limited the rate of cortisol synthesis.

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Series: Acta pædiatrica
ISSN: 0803-5253
ISSN-E: 1651-2227
ISSN-L: 0803-5253
Volume: 105
Issue: 2
Pages: 154 - 158
DOI: 10.1111/apa.13257
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study received funding from the Centre for International Mobility, Finland
Copyright information: ©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd