Objective: To measure the adrenocorticotropic hormone (ACTH) and cortisol (F) cord plasma levels in preterm and term infants in relation to their mode of delivery.
Study design: We studied 180 newborns appropriate for gestational age (GA) with birth weights between 365 and 4380 g and GAs between 21 and 41 weeks divided into three groups: born by vaginal delivery (VD), elective cesarean section (ECS) and emergency cesarean section (EMCS). ACTH and F levels were valued with enzyme-linked immunosorbent assay testing. Median concentrations were compared between groups by Student's T-test for independent and paired data. Multiple regression analysis was used to investigate the effect of GA on F and ACTH concentrations.
Result: A significant positive correlation between GA and plasma concentrations of ACTH (P<0.05) was found in the whole population, but not between GA and F (P=NS). A significant positive correlation was found between GA and plasma concentrations of both ACTH (P=0.01) and F (P=0.03) in VD. In those born by ECS, we demonstrated a positive correlation not only between plasma concentrations of ACTH (P=0.0000) and F (P=0.00002), respectively, with GA, but also a correlation between ACTH and F (P=0.0004). No significant correlations were found in the EMCS group (P=NS).
Conclusion: Our results suggest simultaneous pituitary-adrenal maturation, which is complete only at term. The responsiveness of preterm babies to different stressful stimulations is similar to the terms' but quantitatively lower, and the secretion of ACTH and F may not suffice in severe pathological circumstances.