Document Type

Journal Article

Publication Title

Archives of Disease in Childhood: Fetal & Neonatal

Publisher

BMJ Publishing Group

School

School of Nursing and Midwifery

RAS ID

44317

Funders

Theirworld

MRC Centre for Reproductive Health (MRC G1002033)

British Heart Foundation (RE/18/5/34216)

Comments

Stoye, D. Q., Boardman, J. P., Osmond, C., Sullivan, G., Lamb, G., Black, G. S., & Reynolds, R. M. (2022). Saliva cortisol diurnal variation and stress responses in term and preterm infants. Archives of Disease in Childhood: Fetal & Neonatal, 107(5), 565-567.

http://dx.doi.org/10.1136/archdischild-2021-321593

Abstract

Objective:

To determine if preterm birth is associated with adaptation of the hypothalamic–pituitary–adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at < 28 weeks or very preterm birth at 28–32 weeks gestation).

Design:

This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age.

Setting:

Infants born at a single Scottish hospital.

Participants:

45 term-born, 42 very preterm and 16 extremely preterm infants.

Outcomes:

Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) and mean log-transformed daily cortisol.

Results:

Compared with infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8 nmol/L vs 13.1 nmol/L, difference in means: −7.3 nmol/L, 95% CI −14.0 to −0.6) and a flattened diurnal slope (difference in geometric means: −72.9%, 95% CI −87.1 to −42.8). In contrast, the cortisol response to vaccination (difference in means −2.7 nmol/L, 95% CI −7.4 to 2.0) and diurnal slope at 4 months (difference in geometric means: −33.6%, 95% CI −62.0 to 16.0) did not differ significantly in infants born very preterm compared with infants born at term.

Conclusions:

Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity and could contribute to later metabolic and neurodevelopmental phenotypes observed in this population.

DOI

10.1136/archdischild-2021-321593

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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