Evaluation of Cortisol Level in Premature Neonates: Are There any Correlations between Prevalence of Patent Ductus Arteriosus and Prenatal Administration of Betamethasone?

Document Type: Original Article


1 Department of Neonatology, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Neonatology, Kamali Hospital, Alborz University of Medical Sciences, Alborz, Iran

3 Department of Neonatology, Akbar Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran

4 Department of Cardiology, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: The results of previous studies suggested that there is an increased risk of patent ductus arteriosus (PDA) in the neonates with lower serum cortisol levels. This study aimed to assess the association between serum cortisol values and PDA and investigate if there is an association between PDA and the antenatal administration of betamethasone.
Methods: The present study was carried out on the neonates with gestational age between 28 to 35 weeks. The prenatal administration of betamethasone to the mothers was extracted from the records. A pediatric cardiologist performed an echocardiographic assessment on the second day of life (DOL) and fifth DOL and the infants were evaluated for the presence of PDA. The blood samples were obtained on the second and fifth DOL and serum cortisol levels were measured. We evaluated the association between serum cortisol levels and PDA. Also, the correlation between PDA and the antenatal administration of betamethasone was assessed.
Results: The mean scores of serum cortisol levels on the second DOL in the neonates with and without PDA were 4.99±2.69 (μg/dl) and 7.23±2.87 (μg/dl), respectively that were significantly lower in the first group, compared to those of the second group. However, the mean levels of serum cortisol in the neonates with and without the prenatal administration of betamethasone were not significant (P=0.522).
Conclusion: We have concluded that lower serum cortisol level was associated with the increase in the risk of PDA and the prenatal administration of glucocorticoids may not reduce the occurrence of PDA.


1. Tripathi A, Black GB, Park YM, Jerrel JM. Prevalence and management of patent ductus arteriosus in a pediatric medicaid cohort. Clin Cardiol. 2013; 36(9):502-6.

2. Chorne N, Leonard C, Piecuch R, Clyman RI. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics. 2007; 119(6):1165-74.

3. Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated? Curr Opin Pediatr. 2004; 16(2):146-51.

 4. Arlettaz R. Echocardiographic evaluation of patent ductus arteriosus in preterm infants. Front Pediatr. 2017; 5:147.

5. Watterberg KL, Scott SM, Backstrom C, Gifford KL, Cook KL. Links between early adrenal function and respiratory outcome in preterm infants: airway inflammation and patent ductus arteriosus. Pediatrics. 2000; 105(2):320-4.

 6. Watterberg KL, Gerdes JS, Cole CH, Aucott SW, Thilo EH, Mammel MC, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics. 2004; 114(6):1649-57.

 7. Padbury JF, Ervin MG, Polk DH. Extrapulmonary effects of antenatally administered steroids. J Pediatr. 1996; 128(2):167-72.

8. Waffarn F, Siassi B, Cabal LA, Schmidt PL: Effect of antenatal glucocorticoids on clinical closure of the ductus arteriosus. Am J Dis Child. 1983; 137(4):336-8.

 9. Momma K, Nishihara S, Ota Y. Constriction of the fetal ductus arteriosus by glucocorticoid hormones. Pediatr Res. 1981; 15(1):19-21.

 10. Momma K, Takao A. Increased constriction of the ductus arteriosus with combined administration of indomethacin and betamethasone in fetal rats. Pediatr Res. 1989; 25(1):69-75.

11. Clyman R, Mauray F, Roman C, Rudolph AM, Heymann MA. Glucocorticoids alter the sensitivity of the lamb ductus arteriosus to prostaglandin E2. J Pediatr. 1981; 98(1):126-8.

12. Eronen M, Kari A, Pesonen E, Hallman M. The effect of antenatal dexamethasone administration on the fetal and neonatal ductus arteriosus a randomized double-blind study. Am J Dis Child. 1993; 147(2): 187-92.

13. 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 .

14. Clyman RI, Mauray F, Roman C, Heymann MA, Ballard PL, Rudolph AM, et al. Effects of antenatal glucocorticoid administration on ductus arteriosus of preterm lambs. Am J Physiol. 1981; 241(3): H415-20.

15. Bartholomew J, Kovacs L, Papageorgiou A. Review of the antenatal and postnatal use of steroids. Indian J Pediatr. 2014; 81(5):466-72.