Slide 1
The Endocrine & Metabolic response to Stress in Neonate /
pediatricsPoerwadi , Pediatric Surgeon
TRAUMAX
AdaptMaturSize/shape
ilnessAnesthesiaSurgeryCriticalWOUND HEALINGGROWTH
DEVELOPMENT
Nociceptorschemoreceptors, baroreceptorsStresefferent fibers via
the parasympatheticand sympathetic NS the periphery,neuromuscular
junctions in the circulatory system & receptors at end-organs,
which stimulate the release of peripheral hormones.Afferent(ACTH),
TSH, NE/EVasopressin,ADH, GH, and prolactin release
Stres
nociceptorschemoreceptors, baroreceptorsMechanisms of hormone
release(a) Humoral: in response to changing levels of ions or
nutrients in the blood(b) Neural: stimulation by nerves(c)
Hormonal: stimulation received from other hormones6
7
Hypothalamus__Anterior pituitary__(adenohypophysis)
_____________Posterior pituitary (neurohypophysis)
. have been related to aspects of the hormonal and metabolic
response to surgical or traumatic stressPostoperative or
posttraumatic : morbidity & mortality correlated with the
magnitude and duration of the endocrine and metabolic response to
the stressful event.Severe weight loss, Cardiopulmonary
insufficiency, Thromboembolic disorders, Gastric stress ulcers,
impaired Immunologic function, prolonged convalescence,
ordeathComplications : The hormonal and metabolic response to
stress ( neuro endocrie reflexs) in the neonate & ChildThese
hormonal and metabolic responses to stress in adults have been the
subject of laboratory and clinical investigation for the past
century, however similar responses in newborn infants are not as
well documented.
adaptation immature organs size growth & development thin
subcutan fatRESPONSE?! Morbidity & Mortality
>>>Neonates have well-developed neural pathways for pain
!!!These substances have been shown to be elevated in neonatal
blood following periods of stress and in amniotic fluid during
periods of fetal distress . Altered beta-endorphin levels have also
been demonstrated in neonatal with septic shock
Endorphinshypothalamic receptors sympathetic nervous system
responseCatecholamine ,Endorphines secretion Neonates have
well-developed neural pathways for pain !!!StressNo perioperative
data for neonates have been reported.Boix-Ocha et al.(recently )
published a study examining the cortisol response to operative
stress in neonates and the response to exogenously administered
ACTH .He demonstrated significant increases in cortisol levels
following ACTH administration and noted that this response was
similar to the cortisol increases noted in postoperative
neonates.
Pituitary hormonesAnterior and posterior pituitary hormones
including ACTH, growth hormone, and arginine ADH are liberated in
the adult stress responseStress STRESS E / NE >> (in adult
patients), are responsible for the initiation of the stress-related
catabolic response.Studies investigating in neonates are :Nakai and
Yamada : CA level in asphyxia neonates 2X >>>Anand et al :
CA response to surgery (A highly significant increase in plasma
E/NE concentrations was documented at the end of surgery.
Catecholamines (CA)Pancreatic hormones.
1.Insulin Ross : plasma insulin levels intraoperatively (
catabolic process) negative nitrogen balanceutilization of energy
substrate ability to heal woundscombat infectionsufficient muscular
strength to breathe adequately,Muscle atrophyInfectionWound
dehiscDeath
low caloric reservesThin subcut fatGlycogen stroage
