Comparison between low- and standard-dose ACTH tests in premature infants at risk for chronic lung disease

In order to find a sensitive method to evaluate adrenocortical function in premature infants, we compared low-(0.5 mu g/1.73m(2)) and standard-dose (2 50 mu g/1.73m2) adrenocorticotropin tests (LD- and SD-ACTH) in 12 very-low- birth-weight infants before and 2 days after the end of dexamethasone thera py (duration 9-14 days) for chronic lung disease. Basal serum cortisol leve ls were inappropriately low in several infants already before dexamethasone therapy (median 190, range 60-357 nmol/l), The 95% confidence intervals of mean serum cortisol levels at 20 min were equal in LD- and SD-ACTH, while at 60 min, the low-dose gave a clearly lower response than the standard-dos e test. The LD-ACTH can be used in premature infants as in older children a nd adults, but the criteria for adrenocortical insufficiency need to be def ined. Copyright (C) 2000 S. Karger, AG, Basel.