Plasma aldosterone levels in the 1st week of life in infants of less than 30 weeks gestation
Newborn Intensive Care Unit, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand. European Journal of Pediatrics
(Impact Factor: 1.89).
04/2005; 164(3):141-5. DOI: 10.1007/s00431-004-1572-0
Plasma aldosterone levels were measured in 50 infants of less than 30 weeks gestation at 24 h (D1) and 7 days (D7). The relationship between the plasma aldosterone level and a number of clinical and biochemical variables was explored. Plasma aldosterone levels ranged from 1000 to 30000 pmol/l and were inversely correlated with the severity of illness (D1 or D7), serum sodium (D7) and 24 h sodium intake (D1). No correlation with the serum potassium level was noted. Conclusion:Plasma aldosterone levels in this extremely premature cohort were significantly greater than those reported in more mature infants. Important determinants were severity of illness and sodium homeostasis.
Available from: PubMed Central
- "In extreme prematurity aldosterone concentration can be as high as 12–29,000 pmol/L . In term neonates the average concentration of aldosterone is 22,000 pmol/L  (upper limit of normal range in adult is 970 pmol/L ). During the first year of age, there is a steep, progressive decline in aldosterone to prepubertal concentrations . "
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ABSTRACT: Approximately 75%-80% of patients with Congenital Adrenal Hyperplasia (CAH) fail to synthesize sufficient mineralocorticoids to maintain salt and water balance. In most instances genotype can predict mineralocorticoid deficiency in CAH. Early recognition and replacement with 9alpha-fludrocortisone and salt supplements will prevent development of potentially lethal salt losing crises. In infancy a relative state of aldosterone resistance exists and replacement dose of 9alpha-fludrocortisone based on body surface area is higher during infancy compared to childhood and adults. Salt supplementation is generally not required after weaning is started. Regular monitoring of blood pressure and measurements of plasma electrolytes and renin are required to prevent complications of under or over dosage.
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ABSTRACT: Delay>24 h of age in neonates' first voiding attracts attention, although the phenomenon is usually benign. Earlier studies indicate that stress increases the infant's arginine vasopressin (AVP) and aldosterone secretion during birth. Our aim was to seek predictors of delayed first voiding and indirect evidence of AVP effect behind this phenomenon.
The study population comprised 20 normal-term newborns whose first voiding was delayed>24 h of age (cases), and 19 age-matched control infants who voided for the first time at <24 h of age (controls). The first urine was collected and osmolality (U-Osm) and sodium content (U-Na) measured.
The median of U-osm in cases was 432.50 (284-519) and in controls 337.50 (169-497) mOsm/L (p=0.005), and U-Na 21.50 (9-241) and 40.00 (13-226) mmol/L (p=0.001), respectively. Cases were more frequently born to primiparous mothers than controls (70% vs. 21%, p=0.004). Duration of labour was longer in cases than controls, first stage 10.5 h (3.92-20.50 h) versus 5.7 h (1.17-16.00 h) (p=0.045) and second stage 0.42 h (0.08-1.25 h) versus 0.17 h (0.08-0.92 h) (p=0.015). All seven (35%) abnormal cardiotocographies were recorded with cases (p=0.008).
Delayed voiding appears to be related to a prolonged and stressful birth. Laboratory findings in the first urine suggest increased AVP and aldosterone secretion in such cases.
Available from: edoc.ub.uni-muenchen.de
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