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Analysis of the Influencing Factors of 17-Hydroxyprogesterone Level and the Correlation between 17-Hydroxyprogesterone Level and the Clinical Parameters Related to Adrenal Cortical Function in Very-Low-Birth-Weight Infants

  • Kum, Chang Dae (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Lee, Mi Jin (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Park, Moon Sung (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Sohn, Young Bae (Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Noh, O Kyu (Department of Radiation Oncology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Lee, Jang Hoon (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine)
  • Received : 2018.09.11
  • Accepted : 2018.12.18
  • Published : 2019.02.28

Abstract

Purpose: 17-Hydroxyprogesterone (17-OHP) screening results are difficult to interpret owing to the many influencing factors, and confirming the test results takes time. In this study, we examined the factors that affected the 17-OHP level in premature infants. We also evaluated the correlation between 17-OHP level and the clinical parameters related to adrenal cortical function. Methods: From January 2012 to April 2017, 358 very-low-birth-weight infants (VLBWI) born with birth weights of <1,500 g were included in the study. Their 17-OHP levels were measured in the neonatal screening test after birth and analyzed by considering various factors that may have influenced the values. Results: The 17-OHP levels negatively correlated with gestational age and birth weight. The values of the parameters that affected the 17-OHP levels were significantly higher in the infants with respiratory distress syndrome (RDS). In relation to the clinical parameters, blood pressure measured within 24 hours, 72 hours, and 1 week after birth negatively correlated with the 17-OHP level. Serum sodium and 17-OHP levels 24 hours after birth were found to be positively correlated. Urine outputs in 1 and 3 days after birth showed significant positive correlations with the 17-OHP level. Conclusion: The 17-OHP levels of the VLBWIs were higher when gestational age and birth weight were lower, and were influenced by RDS in the VLBWI. In addition, hypotension and urine output values may be useful in the neonatal intensive care unit as a predictor of early adrenal insufficiency.

Keywords

References

  1. Hughes IA. Congenital adrenal hyperplasia: a continuum of disorders. Lancet 1998;352:752-4. https://doi.org/10.1016/S0140-6736(98)22037-X
  2. Speiser PW, White PC. Congenital adrenal hyperplasia. N Engl J Med 2003;349:776-88. https://doi.org/10.1056/NEJMra021561
  3. Barra CB, Silva IN, Pezzuti IL, Januario JN. Neonatal screening for congenital adrenal hyperplasia. Rev Assoc Med Bras (1992) 2012;58:459-64.
  4. Riepe FG, Sippell WG. Recent advances in diagnosis, treatment, and outcome of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Rev Endocr Metab Disord 2007;8:349-63. https://doi.org/10.1007/s11154-007-9053-1
  5. White PC, Speiser PW. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 2000;21:245-91. https://doi.org/10.1210/edrv.21.3.0398
  6. Sharma R, Seth A. Congenital adrenal hyperplasia: issues in diagnosis and treatment in children. Indian J Pediatr 2014;81:178-85. https://doi.org/10.1007/s12098-013-1280-8
  7. Pang S, Hotchkiss J, Drash AL, Levine LS, New MI. Microfilter paper method for 17 alpha-hydroxyprogesterone radioimmunoassay: its application for rapid screening for congenital adrenal hyperplasia. J Clin Endocrinol Metab 1977;45:1003-8. https://doi.org/10.1210/jcem-45-5-1003
  8. Gruneiro-Papendieck L, Prieto L, Chiesa A, Bengolea S, Bossi G, Bergada C. Neonatal screening program for congenital adrenal hyperplasia: adjustments to the recall protocol. Horm Res 2001;55:271-7. https://doi.org/10.1159/000050012
  9. Honour JW, Torresani T. Evaluation of neonatal screening for congenital adrenal hyperplasia. Horm Res 2001;55:206-11. https://doi.org/10.1159/000049997
  10. Ballerini MG, Chiesa A, Scaglia P, Gruneiro-Papendieck L, Heinrich JJ, Ropelato MG. 17Alpha-hydroxyprogesterone and cortisol serum levels in neonates and young children: influence of age, gestational age, gender and methodological procedures. J Pediatr Endocrinol Metab 2010;23:121-32. https://doi.org/10.1515/jpem.2010.23.1-2.121
  11. Masumoto K, Kusuda S, Aoyagi H, Tamura Y, Obonai T, Yamasaki C, et al. Comparison of serum cortisol concentrations in preterm infants with or without late-onset circulatory collapse due to adrenal insufficiency of prematurity. Pediatr Res 2008;63:686-90. https://doi.org/10.1203/PDR.0b013e31816c8fcc
  12. Steigert M, Schoenle EJ, Biason-Lauber A, Torresani T. High reliability of neonatal screening for congenital adrenal hyperplasia in Switzerland. J Clin Endocrinol Metab 2002;87:4106-10. https://doi.org/10.1210/jc.2002-012093
  13. Cavarzere P, Camilot M, Teofoli F, Tato L. Neonatal screening for congenital adrenal hyperplasia in North-Eastern Italy: a report three years into the program. Horm Res 2005;63:180-6. https://doi.org/10.1159/000085021
  14. van der Kamp HJ, Oudshoorn CG, Elvers BH, van Baarle M, Otten BJ, Wit JM, et al. Cutoff levels of 17-alpha-hydroxyprogesterone in neonatal screening for congenital adrenal hyperplasia should be based on gestational age rather than on birth weight. J Clin Endocrinol Metab 2005;90:3904-7. https://doi.org/10.1210/jc.2004-2136
  15. Allen DB, Hoffman GL, Fitzpatrick P, Laessig R, Maby S, Slyper A. Improved precision of newborn screening for congenital adrenal hyperplasia using weight-adjusted criteria for 17-hydroxyprogesterone levels. J Pediatr 1997;130:128-33. https://doi.org/10.1016/S0022-3476(97)70321-4
  16. Olgemoller B, Roscher AA, Liebl B, Fingerhut R. Screening for congenital adrenal hyperplasia: adjustment of 17-hydroxyprogesterone cut-off values to both age and birth weight markedly improves the predictive value. J Clin Endocrinol Metab 2003;88:5790-4. https://doi.org/10.1210/jc.2002-021732
  17. Kunze M, Hart JE, Lynch AM, Gibbs RS. Intrapartum management of premature rupture of membranes: effect on cesarean delivery rate. Obstet Gynecol 2011;118:1247-54. https://doi.org/10.1097/AOG.0b013e3182351b0c
  18. Ersch J, Beinder E, Stallmach T, Bucher HU, Torresani T. 17-Hydroxyprogesterone in premature infants as a marker of intrauterine stress. J Perinat Med 2008;36:157-60. https://doi.org/10.1515/JPM.2008.013
  19. Paul DA, Leef KH, Stefano JL, Bartoshesky L. Factors influencing levels of 17-hydroxyprogesterone in very low birth weight infants and the relationship to death and IVH. J Perinatol 2004;24:252-6. https://doi.org/10.1038/sj.jp.7211066
  20. Chung HR, Shin CH, Yang SW, Yun KA, Lee YA, Park SE, et al. Interpretation of screening for congenital adrenal hyperplasia in preterm infants. Korean J Pediatr 2008;51:616-21. https://doi.org/10.3345/kjp.2008.51.6.616
  21. Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Saugstad OD, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med 2007;35:175-86.
  22. R Core Team. R: a language and environment for the statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 2019 [cited 2019 Jan 4]. Available from: https://cran.r-project.org/mirrors.html.
  23. Cavarzere P, Samara-Boustani D, Flechtner I, Dechaux M, Elie C, Tardy V, et al. Transient hyper-17-hydroxyprogesteronemia: a clinical subgroup of patients diagnosed at neonatal screening for congenital adrenal hyperplasia. Eur J Endocrinol 2009;161:285-92. https://doi.org/10.1530/EJE-09-0145
  24. Choi YS, Lee BS, Kim KS, Kim EA. Study of 17-alpha-hydroxy progesterone in preterm infants. J Korean Soc Neonatol 2012;19:77-83. https://doi.org/10.5385/jksn.2012.19.2.77
  25. Ryckman KK, Cook DE, Berberich SL, Shchelochkov OA, Berends SK, Busch T, et al. Replication of clinical associations with 17-hydroxyprogesterone in preterm newborns. J Pediatr Endocrinol Metab 2012;25:301-5. https://doi.org/10.1515/jpem-2011-0456
  26. Chennuri VS, Mithbawkar SM, Mokal RA, Desai MP. Serum 17 alpha hydroxyprogesterone in normal full term and preterm vs sick preterm and full term newborns in a tertiary hospital. Indian J Pediatr 2013;80:21-5.
  27. Anandi VS, Shaila B. Evaluation of factors associated with elevated newborn 17-hydroxyprogesterone levels. J Pediatr Endocrinol Metab 2017;30:677-81. https://doi.org/10.1515/jpem-2016-0459
  28. King JL, Naber JM, Hopkin RJ, Repaske DR, Bailey L, Leslie ND. Antenatal corticosteroids and newborn screening for congenital adrenal hyperplasia. Arch Pediatr Adolesc Med 2001;155:1038-42. https://doi.org/10.1001/archpedi.155.9.1038
  29. Gatelais F, Berthelot J, Beringue F, Descamps P, Bonneau D, Limal JM, et al. Effect of single and multiple courses of prenatal corticosteroids on 17-hydroxyprogesterone levels: implication for neonatal screening of congenital adrenal hyperplasia. Pediatr Res 2004;56:701-5. https://doi.org/10.1203/01.PDR.0000142733.50918.6E
  30. Travers S, Martinerie L, Boileau P, Lombes M, Pussard E. Alterations of adrenal steroidomic profiles in preterm infants at birth. Arch Dis Child Fetal Neonatal Ed 2018;103:F143-51. https://doi.org/10.1136/archdischild-2016-312457
  31. Ng PC, Lam CW, Fok TF, Lee CH, Ma KC, Chan IH, et al. Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed 2001;84:F122-4. https://doi.org/10.1136/fn.84.2.F122
  32. Ng PC, Lee CH, Lam CW, Ma KC, Fok TF, Chan IH, et al. Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2004;89:F119-26. https://doi.org/10.1136/adc.2002.021972
  33. Berry J, Betts P, Wood PJ. The interpretation of bloodspot 17 alpha-hydroxyprogesterone levels in term and pre-term neonates. Ann Clin Biochem 1986;23(Pt 5):546-51. https://doi.org/10.1177/000456328602300510
  34. Ohkubo S, Shimozawa K, Matsumoto M, Kitagawa T. Analysis of blood spot 17 alpha-hydroxyprogesterone concentration in premature infants: proposal for cut-off limits in screening for congenital adrenal hyperplasia. Acta Paediatr Jpn 1992;34:126-33. https://doi.org/10.1111/j.1442-200X.1992.tb00938.x
  35. Hingre RV, Gross SJ, Hingre KS, Mayes DM, Richman RA. Adrenal steroidogenesis in very low birth weight preterm infants. J Clin Endocrinol Metab 1994;78:266-70. https://doi.org/10.1210/jc.78.2.266
  36. Huysman MW, Hokken-Koelega AC, De Ridder MA, Sauer PJ. Adrenal function in sick very preterm infants. Pediatr Res 2000;48:629-33. https://doi.org/10.1203/00006450-200011000-00013
  37. Riepe FG, Mahler P, Sippell WG, Partsch CJ. Longitudinal study of plasma pregnenolone and 17-hydroxypregnenolone in fullterm and preterm neonates at birth and during the early neonatal period. J Clin Endocrinol Metab 2002;87:4301-6. https://doi.org/10.1210/jc.2002-020452
  38. Krasowski MD, Drees D, Morris CS, Maakestad J, Blau JL, Ekins S. Cross-reactivity of steroid hormone immunoassays: clinical significance and two-dimensional molecular similarity prediction. BMC Clin Pathol 2014;14:33. https://doi.org/10.1186/1472-6890-14-33