Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm

Watterberg, Kristi L.; Hintz, Susan R.; Do, Barbara; Vohr, Betty R.; Lowe, Jean; Newman, Jamie; Wallace, Dennis; Lacy, Conra Backstrom; Davis, Elysia Poggi; Shankaran, Seetha; Payne, Allison H.; Higgins, Rosemary D.

doi:10.1038/s41390-018-0243-1

Cited by 17 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, other groups also studied cortisol in former preterm children compared to children born at term of a similar age group as in our study, i.e., 6–7 years: Watterberg et al ( 40 ) also hypothesized preterm-born children to have increased cortisol compared to term-born children. They measured salivary cortisol levels four times during a study visit and in addition three specimen were obtained at home to analyze diurnal patterns.…”

Section: Discussionsupporting

confidence: 51%

“…Moreover, different methods for measuring cortisol can be used. Measurements in saliva reflect cortisol production at selected points in time ( 40 – 43 ). Urinary steroid profiling as applied by Gohlke et al ( 44 ) in morning urine samples and in our study in 24-h urinary specimens, however, represent integrated measurements, i.e., excretion rates of cortisol and thus allow for the assessment of hormonal production rates.…”

Section: Discussionmentioning

confidence: 99%

“…Meuwese et al ( 46 ) measured higher DHEA concentrations in serum from young adults born preterm. Watterberg et al ( 40 ) measured salivary DHEA in 5–7-year-old children born preterm as compared to children born at term. In morning urine samples obtained from 36 children aged 8–11 years who were born preterm, Gohlke et al ( 44 ) reported higher cortisol and cortisol metabolites and adrenal androgens as compared to 36 peers born at term.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term

et al. 2021

View full text Add to dashboard Cite

Background: Previous studies indicated preterm birth to be a risk factor for hypertension in adolescence and adulthood. However, studies in children investigating the underlying mechanisms are scarce.Objective: We hypothesized children born preterm to have higher excretion of cortisol and/or androgen metabolites per day concomitantly with higher blood pressure as compared to peers born at term. We thus aimed to compare urinary steroid profiles and blood pressure between 5- to 7-year-old children born preterm and peers born at term. Furthermore, aldosterone precursor excretion per day was compared between both groups.Methods: Blood pressure was measured in 236 children (preterms n = 116; gestational age 29.8 ± 2.6 (30; 24–33) weeks [mean ± standard deviation (median; range)]) using an automatic oscillometric device. Urinary steroid profiles were determined in 24-h urine samples (preterms n = 109; terms n = 113) using gas chromatographic-mass spectrometric analysis. To assess excretion of cortisol and androgen metabolites per day, major cortisol and androgen metabolites were summed, respectively. To assess aldosterone excretion per day tetrahydrocorticosterone, 5α-tetrahydrocorticosterone, and tetrahydro-11-deydrocorticosterone were summed.Results: Multiple regression analyses showed prematurity to be associated with systolic but not with diastolic blood pressure. When adjusted for potential confounders (prematurity, gender, age at day of examination, being born small for gestational age, breastfeeding, accelerated weight gain during infancy, family history of cardiovascular disease, parental hypertension, and body mass index) prematurity was shown to be associated with an increase in systolic blood pressure by 2.87 mmHg (95% confidence interval 0.48–5.27; p = 0.02). Cortisol, androgen metabolite, and aldosterone precursor excretion per day were not higher in individuals born preterm. In contrast to our hypothesis, multiple regression analysis showed prematurity to independently decrease cortisol and aldosterone precursor excretion per day (p < 0.001 and 0.04, respectively).Conclusion: This study provides further evidence for systolic blood pressure to be higher after preterm birth as early as at the age of 5 to 7 years. However, this seems not to be explained by elevated excretion of cortisol and/or androgen metabolites.

show abstract

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In support of this conjecture, at age 6 years at the start of formal schooling, Watterberg et al. (2018) found no differences in salivary cortisol levels across a period of neurodevelopmental testing in children born extremely preterm compared to full‐term controls, although blunted morning cortisol levels were evident. Overall, the nature of early life HPA axis “programming” in relation to NICU pain‐related stress in children born very preterm appears to be non‐linear across development and should be examined further.…”

Section: Discussionmentioning

confidence: 93%

Sensory processing and cortisol at age 4 years: Procedural pain‐related stress in children born very preterm

McLean

Niknafs

Scoten

et al. 2020

Developmental Psychobiology

View full text Add to dashboard Cite

Children born preterm display altered sensory processing, which may manifest as hyper‐ and/or hypo‐sensitivity to sensory information. In this vulnerable population, exposure to neonatal pain‐related stress is associated with altered stress regulation, as indexed by alterations in cortisol levels. It is unknown whether sensory processing behaviors are also affected by early life adversity, and whether dysregulated cortisol is related to sensory processing problems in preterm children. We examined relationships between neonatal pain‐related stress, sensory processing profiles and cortisol levels at age 4 years, and whether pathways were sex‐specific. In a longitudinal prospective cohort study, N = 146 infants born 24–32 weeks gestational age were recruited from BC Women's Hospital, Vancouver, BC, Canada; neonatal factors were collected from daily chart review. At age 4 years, saliva to assay cortisol was collected three times across cognitive assessment (pre‐test, during, end) and parents completed the Short Sensory Profile questionnaire. Using generalized linear modeling, independent of other neonatal factors, higher number of invasive procedures (pain/stress) was associated with more sensory processing problems (total, hypo‐ and hyper‐sensitivity) for girls only. After accounting for neonatal factors, greater cortisol output across the assessment was associated with more total sensory processing problems in girls only, and hypersensitivity to sensory input in both boys and girls. Findings suggest that in children born very preterm, how a child responds to sensory input and cortisol reactivity to stress are related but may have different precursors. Girls may be somewhat more susceptible to neonatal pain‐related stress exposure in relation to sensory processing at preschool age.

show abstract

“…This study is the first to address whether preterm birth influences diurnal slope in infancy. However, available data from studies in childhood are indicative of a flattening of the HPA axis after preterm birth, including two reports of reduced morning cortisol24 25 and one of increased evening cortisol concentrations 23. Furthermore, a flatter diurnal cortisol slope and blunted cortisol reactivity to stressors are patterns of HPA axis regulation frequently observed after childhood adversity 13 14 26…”

Section: Discussionmentioning

confidence: 99%

Saliva cortisol diurnal variation and stress responses in term and preterm infants

Stoye

Boardman

Osmond

et al. 2022

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

ObjectiveTo 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).DesignThis 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.SettingInfants born at a single Scottish hospital.Participants45 term-born, 42 very preterm and 16 extremely preterm infants.OutcomesCortisol 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.ResultsCompared 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.ConclusionsInfants 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.

show abstract

Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm

Cited by 17 publications

References 46 publications

Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term

Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term

Sensory processing and cortisol at age 4 years: Procedural pain‐related stress in children born very preterm

Saliva cortisol diurnal variation and stress responses in term and preterm infants

Contact Info

Product

Resources

About