Relative Adrenal Insufficiency in Full-Term and Preterm Neonates with Neonatal Sepsis

Background: Neonatal sepsis is the third most common cause of death in newborns and a significant issue for public health, particularly in developing nations. This study aimed to assess the hypothalamic-pituitary-adrenal axis (HPA) response in full-term and preterm newborns diagnosed with neonatal sepsis in the neonatal intensive care unit (NICU).

Methods: This cross-section observational research was done on neonates who were categorized into two main groups Group I: Sepsis neonates who were further subdivided into two groups according to the gestational age into 30 full-term neonates with neonatal sepsis and 30 preterm neonates with neonatal sepsis. Group II: Included 30 healthy control neonates.

Results: HSS score and C reactive protein (CRP) level were correlated with serum cortisol level at (9 am: r=-0.273, P<0.035 and r=-0.447, P<0.001), (9 pm: r=-0.447, P<0.001and r=-0.477, P<0.001) ACTH at (9 am: r=-0.314, P<0.015 and r=-0.377, P<0.003) and at (9 pm: r= -0.362, P<0.005 and r=-0.448, P<0.001) and cortisol level post ACTH stimulation (r=-0.345, 0.007 and r=-0.497, P<0.001) respectively. Regarding inotropes, sepsis type and oxygen support there was significant difference between both groups.

Conclusions: 75% of the patients we evaluated with neonatal sepsis had relative adrenal insufficiency (RAI). ACTH and Cortisol values were correlated to CRP and HSS score as an inflammatory marker. This reflects suppressed HPA status in this critical clinical condition.