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Current Pediatric Reviews

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ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

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Research Article

Cord Blood Cortisol Level - A Possible Predictor for Respiratory Distress Syndrome in Preterm Neonates

Author(s): Anup John Thomas*, Dhandapany Gunasekaran, Chandrasekaran Venkatesh, Nanda Chhavi and Soundararajan Palanisamy

Volume 21, Issue 3, 2025

Published on: 08 January, 2024

Page: [276 - 282] Pages: 7

DOI: 10.2174/0115733963246135231228100531

Price: $65

TIMBC 2026
Abstract

Background: Respiratory Distress Syndrome (RDS) is a leading cause of death in premature infants. There are different clinical/ biochemical markers associated with the RDS. One of the potential biochemical markers is cortisol in cord blood.

Aims: This study aims to correlate cortisol levels in preterm neonates with RDS and to establish whether cord blood cortisol is a reliable predictor for RDS.

Materials and Methods: This prospective analytical study was conducted in a tertiary care hospital over nine months among fifty preterm neonates. Data was collected using proforma, and cord blood was collected at the time of delivery. Cortisol levels were compared and correlated to the development of RDS.

Results and Discussion: The mean ± SD cord blood cortisol level among preterm neonates was 5.97 ± 2.74 (SD) μg/dl. The levels were higher in neonates whose mothers received antenatal steroids and were significantly lower (2.86 ± 1.66 μg/dl) in those who developed RDS. Association between cord blood cortisol level and RDS was found with an odds ratio of 57.4, which was statistically significant.

The percentage of babies developing RDS in mothers not covered with antenatal steroids was significantly higher than those covered (p-value is 0.000).

The mean cord blood cortisol levels were exceptionally low (1.89 μg/dl) in neonates who expired compared to those who survived (7.02 μg/dl).

Conclusion: There is an association between cord blood cortisol levels and RDS. Hence, Cord blood cortisol levels may be used to predict RDS and help initiate early treatment, thus preventing mortality and morbidity.

Keywords: Antenatal steroids, cord blood, cortisol, preterm, respiratory distress syndrome, neonates.

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[1]
Preterm birth Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth [cited 2023 Jul 4].
[2]
García-Basteiro AL, Quintó L, Macete E, et al. Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study. PLoS One 2017; 12(2): e0172533.
[http://dx.doi.org/10.1371/journal.pone.0172533] [PMID: 28212393]
[3]
Lee ACC, Katz J, Blencowe H, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health 2013; 1(1): e26-36.
[http://dx.doi.org/10.1016/S2214-109X(13)70006-8] [PMID: 25103583]
[4]
Conly PW, LeMaire WJ, Monkus EF, Cleveland WW. Plasma estriol concentration in infants with the respiratory distress syndrome. J Pediatr 1973; 83(5): 851-3.
[http://dx.doi.org/10.1016/S0022-3476(73)80388-9] [PMID: 4742582]
[5]
Liszewski MC, Lee EY. Neonatal lung disorders: Pattern recognition approach to diagnosis. AJR Am J Roentgenol 2018; 210(5): 964-75.
[http://dx.doi.org/10.2214/AJR.17.19231] [PMID: 29489412]
[6]
Yadav S, Lee B, Kamity R. Neonatal respiratory distress syndrome. StatPearls. Treasure Island, FL: StatPearls Publishing 2023.http://www.ncbi.nlm.nih.gov/books/NBK560779/ Internet
[7]
Ekhaguere OA, Okonkwo IR, Batra M, Hedstrom AB. Respiratory distress syndrome management in resource limited settings—Current evidence and opportunities in 2022. Front Pediatr 2022; 10: 961509.
[http://dx.doi.org/10.3389/fped.2022.961509] [PMID: 35967574]
[8]
Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. AMA J Dis Child 1959; 97(5, Part 1): 517-23.
[PMID: 13649082]
[9]
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3(3): CD004454.
[PMID: 28321847]
[10]
Sybulski S, Maughan GB. Relationship between cortisol levels in umbilical cord plasma and development of the respiratory distress syndrome in premature newborn infants. Am J Obstet Gynecol 1976; 125(2): 239-43.
[http://dx.doi.org/10.1016/0002-9378(76)90600-1] [PMID: 1266904]
[11]
Wynne K, Rowe C, Delbridge M, Watkins B, Brown K, Addley J, et al. Antenatal corticosteroid administration for foetal lung maturation. F1000Research 2020. F1000 Faculty Rev-219.
[12]
Floros J, Post M, Smith BT. Glucocorticoids affect the synthesis of pulmonary fibroblast-pneumonocyte factor at a pretranslational level. J Biol Chem 1985; 260(4): 2265-7.
[http://dx.doi.org/10.1016/S0021-9258(18)89548-5] [PMID: 3972789]
[13]
Caspi E, Schreyer P, Weinraub Z, Bukovsky I, Tamir I. Changes in amniotic fluid lecithin-sphingomyelin ratio following maternal dexamethasone administration. Am J Obstet Gynecol 1975; 122(3): 327-31.
[http://dx.doi.org/10.1016/0002-9378(75)90178-7] [PMID: 1173325]
[14]
Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71(2): 159-63.
[http://dx.doi.org/10.1016/S0022-3476(67)80066-0] [PMID: 6029463]
[15]
Ng PC. The fetal and neonatal hypothalamic-pituitary-adrenal axis. Arch Dis Child Fetal Neonatal Ed 2000; 82(3): 250F-4.
[http://dx.doi.org/10.1136/fn.82.3.F250] [PMID: 10794797]
[16]
Gillam-Krakauer M, Gowen CW Jr. Birth Asphyxia. StatPearls. Treasure Island, FL: StatPearls Publishing 2023. http://www.ncbi. nlm.nih.gov/books/NBK430782/ Internet
[17]
Downes JJ, Vidyasagar D, Morrow GM, Boggs TR. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr 1970; 9(6): 325-31.
[http://dx.doi.org/10.1177/000992287000900607] [PMID: 5419441]
[18]
Ballard PL, Ballard RA. Glucocorticoid receptors and the role of glucocorticoids in fetal lung development. Proc Natl Acad Sci U S A 1972; 69(9): 2668-72.
[http://dx.doi.org/10.1177/1054773817705541] [PMID: 28447852]
[19]
Srivastava T, Merchant RH, Ambadekar MC. Cord blood cortisol levels and respiratory distress syndrome. Indian Pediatr 1994; 31(8): 923-8.
[PMID: 7883344]
[20]
Nykänen P, Raivio T, Heinonen K, Jänne OA, Voutilainen R. Circulating glucocorticoid bioactivity and serum cortisol concentrations in premature infants: The influence of exogenous glucocorticoids and clinical factors. Eur J Endocrinol 2007; 156(5): 577-83.
[http://dx.doi.org/10.1530/EJE-06-0672] [PMID: 17468194]
[21]
Ballard PL, Gluckman PD, Liggins GC, Kaplan SL, Grumbach MM. Steroid and growth hormone levels in premature infants after prenatal betamethasone therapy to prevent respiratory distress syndrome. Pediatr Res 1980; 14(2): 122-7.
[http://dx.doi.org/10.1203/00006450-198002000-00011] [PMID: 6444710]
[22]
Prevalence and etiology of respiratory distress in newborns in the fallujah teaching hospital for women and children Healthy Newborn Network 2020. Available from: https://www.healthynewbornnetwork.org/resource/prevalence-and-etiology-of-respiratory-distress-in-newborns-in-the-fallujah-teaching-hospital-for-women-and-children/ [cited 2023 Jul 4].
[23]
Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50(4): 515-25.
[http://dx.doi.org/10.1542/peds.50.4.515] [PMID: 4561295]
[24]
McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020; 12(12): CD004454.
[PMID: 33368142]
[25]
Care of the newborn 8e hardcover – 31 Jan 2015 by Singh M. (Author) 2015. Available from: https://www.professionalbookhouse.com/9788123925882-care-of-the-newborn-8e-hardcover-31- jan-2015-by-singh-m [cited 2023 Jul 5].
[26]
Murphy BEP. Cortisol and cortisone levels in the cord blood at delivery of infants with and without the respiratory distress syndrome. Am J Obstet Gynecol 1974; 119(8): 1112-20.
[http://dx.doi.org/10.1016/0002-9378(74)90268-3] [PMID: 4858798]
[27]
Lee JA, Kim BI, Shim SY, Shin YJ, Kim EK, Kim HS, et al. Thymus Size and its Relationship to the Respiratory Distress Syndrome and Cord Blood Cortisol Level in the Preterm Infants. J Korean Soc Neonatol. 2004; pp. 192-202.
[28]
Effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome**See Editorial Comment following this article. Am J Obstet Gynecol 1981; 141(3): 276-87.
[http://dx.doi.org/10.1016/S0002-9378(16)32633-3] [PMID: 7025638]

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