الفهرس 
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Abstract
Neonatal sepsis is one the major causes of morbidity and mortality among the newborns.
Septic shock causes a state of derangement in different body organs. (C.V.S., renal, resp, etc …) in addition to its effect on the endocrinal systems including Hypothalamic pituitary adrenal axis.
Sepsis and septic shock is one of the most common cause of adrenal insufficiency in the critically ill neonates.
Relative adrenal insufficiency is present when cortisol response is inadequate for the patient degree of stress, despite a cortisol level that may appear normal due to a dysfunction at any point in the hypothalamic pituitary adrenal axis or due to resistance to glucocorticoid.
So, the present study aimed to assess the hypothalamic pituitary adrenal axis response in the crtically ill neonates with septic shock.
This study was conducted on 60 neonates divided into three group: group A included 30 critically ill neonates with septic shock on inotropic support. (15 preterm and 15 fullterm) of whom 22/30 (73.3%) received double inotropes (dopamine and doubtamine) and 8/30 (26.6%) received triple inotropes (dopamine, doubtamine and norepinephrine), group B included 15 septic neonates without inotropic support (9 preterm and 6 full term) and (group C) 15 healthy neonates (8 preterm, and 7 full term).
All the studied neonates were subjected to careful history taking laying stress on pretnatal maternal condition, maturity and previous NICU admission excluding neonates with congenital malformation, adrenal disease, neonates showing signs of other endocrinal disorders and/or with history of post natal steroid therapy.
Medical examination included maturity assessment, peripheral capillary perfusion assessment, signs of shock and mean arterial blood pressure before and after inotropic support. Laboratory assessment included markers of sepsis (CBC, TLC and CRP), serum electrolytes, blood glucose and total serum cortisol (am, pm) and serum ACTH.
The results of this study showed that in group A and group B, positive blood cultures were recorded in 27/45 (60%), 19/30 (63.3%) in group A and 8/15(53.3%) in group B.
Gram negative organism was more prevalent in both groups presenting 35.5% (16/45) while gram positive organism presents 11/45 (24.4%).
This result also showed a highly statistical significant over all rise of total serum cortisol level and ACTH in group A compared to the other two groups.
Four patterns of serum cortisol response were recorded in group A ranging from very high cortisol level to a near normal values. Presenting a state of glucocorticoid resistance, relative adrenal insufficiency and adrenal exhaustion respecitvely.
Within group A (post inotropic support), preterms showed labile blood pressure measurements and a more pronounced state of vasopressor resistance hypotension in comparison to fullterms of the same group.
The rise of ACTH in group A indicated a state a pituitary dependent mechanism of stimulation in neonates with septic shock.
Septic shock causes a state of relative adrenal insufficiency that contributes to the shock state leading to higher mortality rate.
Hydrocortisone therapy can improve the state of vassopressor resistance hypotension leading to a better clinical outcome.