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Neonatologists’ practices in screening and managing corticosteroid-induced adrenal insufficiency in the NICU- a multicenter study

Journal of Perinatology (2026)Cite this article

Subjects

Abstract

Objective

To examine the variability in neonatologists’ screening and management practices of corticosteroid-induced adrenal insufficiency (adrenal suppression; AS) in the NICU.

Study design

A cross-sectional survey was disseminated nationally via REDCap® to 160 neonatologists who serve as members of Children’s Hospitals Neonatal Consortium. Descriptive statistics were used to capture variability in AS screening modalities, diagnostic tools, management approaches, and discharge planning.

Result

Of the 82 respondents, only 56.1% screen infants for AS following prolonged systemic corticosteroid exposure, 46.3% after 2–4 weeks, 59.8% utilizing ACTH stimulation testing. Only 2.4% screen after prolonged high dose inhaled corticosteroids, reflecting uncertainty regarding their suppressive potential. Additionally, only 30.5% provide structured caregiver AS education at discharge.

Conclusion

Variable nationwide screening and management of adrenal suppression in the NICU underscores uncertainty and inconsistency in practice, revealing the need for clinical guidelines to optimize care.

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Acknowledgements

We would like to thank faculty and staff at the Atrium Health Wake Forest Baptist Brenner Children’s NICU and Pediatric Endocrinology, the Atrium Health Levine Children’s Hospital NICU, the neonatologists at all participating CHNC centers, the CHNC leadership, and the CHNC Endocrinology focus group for their participation and feedback.

Author information

Authors and Affiliations

  1. Wake Forest University School of Medicine, Department of Neonatology, Winston-Salem, NC, USA

    Sean Christopher Watson & Parvesh Mohan Garg

  2. Wake Forest University School of Medicine, Department of Pediatrics-Endocrinology, Winston-Salem, NC, USA

    Cathrine Constantacos

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  1. Sean Christopher Watson
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  2. Parvesh Mohan Garg
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  3. Cathrine Constantacos
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Contributions

CC and SCW designed the study. CC and SCW collected and analyzed the data. CC, SCW, and PMG equally contributed to the writing of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Cathrine Constantacos.

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The manuscript is original, has not been published elsewhere, and is not currently under review by any other journal. All authors have read and approved the manuscript and agree with its submission to the Journal of Perinatology. All authors declare no competing financial or non-financial conflicts. All authors have read and approved the manuscript and agree with its submission to the Journal of Perinatology. All authors declare no competing financial or non-financial interests in relation to the work described.

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Watson, S.C., Garg, P.M. & Constantacos, C. Neonatologists’ practices in screening and managing corticosteroid-induced adrenal insufficiency in the NICU- a multicenter study. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02592-2

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