Adrenal insufficiency in neonates undergoing cardiopulmonary bypass and postoperative hypothalamic-pituitary-adrenal function after prophylactic glucocorticoids

J Perinatol. 2019 May;39(5):640-647. doi: 10.1038/s41372-019-0344-7. Epub 2019 Mar 12.


Objectives: Determine incidence of preoperative adrenal insufficiency in neonates >35 weeks gestation with congenital heart disease undergoing cardiothoracic surgery with bypass and effects of prophylactic methylprednisolone on postoperative hypothalamic-pituitary-adrenal function and hemodynamic stability.

Design: Prospective observational study in 36 neonates with preoperative adrenocorticotrophic hormone stimulation tests and serial total cortisol and adrenocorticotrophic hormone measurements before and after surgery. Data analyses: analysis of variance and regression.

Results: Baseline circulating adrenocorticotrophic hormone and cortisol were unchanged 4-20 days postnatal (P > 0.1); however, cortisol levels rose with increasing adrenocorticotrophic hormone, P = 0.02. Ten neonates (29%) demonstrated preoperative adrenal insufficiency (∆cortisol ≤9 µg/dl); one had postoperative hemodynamic instability. Growth-restricted neonates had lower baseline cortisol, but normal stimulation tests and responded well to surgical stresses. Seventy-five percent of neonates receiving perioperative methylprednisolone demonstrated postoperative hypothalamic-pituitary-adrenal inhibition.

Conclusion: Adrenal insufficiency appears common in neonates >35 weeks gestation with congenital heart disease, but did not contribute to postoperative hemodynamic instability despite hypothalamic-pituitary-adrenal inhibition.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Insufficiency / drug therapy
  • Adrenal Insufficiency / physiopathology*
  • Adrenocorticotropic Hormone / blood
  • Cardiopulmonary Bypass / adverse effects*
  • Female
  • Glucocorticoids / therapeutic use*
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / surgery*
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Infant, Newborn
  • Linear Models
  • Male
  • Pituitary-Adrenal System / physiopathology*
  • Prospective Studies


  • Glucocorticoids
  • Adrenocorticotropic Hormone
  • Hydrocortisone