Diagnostic Value of Salivary Cortisol in the CRH Stimulation Test in Premature Infants

Matsukura, Tadashi; Kawai, Masahiko; Marumo, Chieko; Iwanaga, Kougoro; Yoshida, Kayo; Shibata, Minoru; Niwa, Fusako; Hasegawa, Takeshi; Heike, Toshio

doi:10.1210/jc.2011-1814

Cited by 19 publications

(20 citation statements)

References 36 publications

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“…This finding confirms the reliability of salivary cortisol measurements shown before in premature infants (15) and older children (16). We did not find the inverse relation between birth weight and cortisol levels as shown in other studies in children (7,17).…”

Section: Articles De Jong Et Alsupporting

confidence: 91%

Salivary and serum cortisol and relation to blood pressure in infancy and early childhood in very-low-birth-weight infants

2015

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Section: Articles De Jong Et Alsupporting

confidence: 91%

Salivary and serum cortisol and relation to blood pressure in infancy and early childhood in very-low-birth-weight infants

2015

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“…Three [15,17,19] of four [15][16][17]19] identified studies on correlation between plasma and salivary cortisol in preterm infants did not report on exact weight and postmenstrual age of investigated infants at sample recovery. The rate of infants that could not be studied because of inadequate saliva sample size was only reported by Matsukura et al [17] . In this study more than 50% of preterm infants (9/17) could not be investigated at 2 weeks of age because there was insufficient saliva recovered.…”

Section: Patientsmentioning

confidence: 99%

Relationship of Salivary and Plasma Cortisol Levels in Preterm Infants: Results of a Prospective Observational Study and Systematic Review of the Literature

et al. 2014

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BACKGROUND AND OBJECTIVES: (1) To investigate the relationship of salivary and plasma cortisol levels in preterm infants with a focus on the usability of salivary cortisol in diagnostic work-up of infants at risk of adrenal insufficiency. (2) To perform a systematic review addressing this question. METHODS: Clinical study: We conducted a prospective observational single-center study in preterm infants. We analyzed plasma and saliva cortisol concentrations by enzyme immunoassay. Correlation analysis was used to determine the relation between salivary and plasma cortisol levels and the agreement of the measurement methods was analyzed according to Bland-Altman. Systematic review: A systematic literature search (PubMed and Embase) on the relationship of salivary and plasma cortisol levels in neonates was performed in November 2012. RESULTS: Clinical study: We enrolled 58 preterm infants (median (interquartile range) gestational age at birth was 31.4 (28.1-32.7) weeks, birth weight 1,340 (974-1,745) g, respectively). Correlation analyses revealed a relationship of plasma cortisol and salivary cortisol levels. Rank correlation coefficient was 0.6. Estimating plasma cortisol levels based on measured salivary cortisol levels showed poor agreement of the two methods for determining plasma cortisol levels (direct and via salivary cortisol). Sensitivity and specificity of salivary cortisol for the detection of adrenal insufficiency were 0.66 and 0.62, respectively. Systematic review: Six studies in preterm infants and term neonates depicting the correlation of salivary and plasma cortisol were identified with a range of saliva-plasma correlation coefficients from 0.44 to 0.83. CONCLUSIONS: Substitution of plasma cortisol by salivary cortisol determination cannot be recommended in preterm infants because of unsatisfactory agreement between methods. tionship of plasma cortisol and salivary cortisol levels. Rank correlation coefficient was 0.6. Estimating plasma cortisol levels based on measured salivary cortisol levels showed poor agreement of the two methods for determining plasma cortisol levels (direct and via salivary cortisol). Sensitivity and specificity of salivary cortisol for the detection of adrenal insufficiency were 0.66 and 0.62, respectively. Systematic review: Six studies in preterm infants and term neonates depicting the correlation of salivary and plasma cortisol were identified with a range of saliva-plasma correlation coefficients from 0.44 to 0.83. Conclusions: Substitution of plasma cortisol by salivary cortisol determination cannot be recommended in preterm infants because of unsatisfactory agreement between methods.

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“…The procedure of obtaining saliva is painless and free from stress to the infants [18]. A few studies have reported on the relationship between plasma and salivary cortisol in term [20][21][22] infants.…”

Section: Discussionmentioning

confidence: 99%

“…Matsukura et al reported good correlation between plasma and salivary cortisol levels in preterm infants (mean gestational age at birth 26.7 weeks) during Corticotropin Releasing Hormone (CRH) stimulation test [20]. Calixto et al reported a good correlation between salivary and plasma cortisol levels in preterm infants during an ACTH stimulation test [17] in a study population of mean gestational age of 30.6 weeks at birth.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of Plasma and Salivary Cortisol in Extremely Premature Infants

Ng¹,

Drury²,

Upradrasta³

et al. 2017

J Neonatal Biol

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IntroductionAntenatal administration of glucocorticoids to mothers at risk of preterm labour is known to improve production of surfactant in the neonate born prematurely, thus aiding maturation of lungs. Plasma cortisol concentration is expected to increase during significant stress [1,2] and recent studies in neonates by serial blood sampling have shown that cortisol is secreted in short pulses every 80 minutes [3]. These rapid pulsations are called ultradian rhythms and are caused by hypothalamic pituitary signalling. Arnold et al. [4] have shown that these secretory pulses in neonates exposed to antenatal glucocorticoids are shorter compared to neonates who have not been exposed to antenatal glucocorticoids.Plasma cortisol concentrations are affected by intrinsic factors (for example, immaturity of the hypothalamic-pituitary-adrenal (HPA) axis, physiological decline of plasma cortisol during the immediate post-partum period, effect of antenatal steroids on HPA axis) and extrinsic factors (for example, vaginal delivery, poor condition at birth, respiratory distress, mechanical ventilation, hypoglycaemia or infection) [5]. Extremely preterm infants may develop adrenal insufficiency in the early neonatal period requiring cortisol supplementation [6,7]. In these infants, hypotension may occur which is responsive to the administration of hydrocortisone [8]. Assessment of adrenal function in extremely premature infants by the administration of ACTH for a synacthen test is difficult because sequential blood sampling is required for determination of cortisol levels.Measurement of free cortisol is the best indicator of adrenal glucocorticoid secretion [9] because cortisol is more than 80% bound to cortisol binding globulins (CBG) in the circulation and therefore measurements of plasma cortisol can be compromised by conditions that alter CBG levels [10,11]. However, obtaining blood samples by venepuncture is a painful procedure, which might of itself cause high cortisol values [12] and free cortisol may be better tested by taking saliva samples [13] because salivary cortisol levels are known to accurately reflect the free fraction of cortisol in the body. Obtaining saliva is painless and non-invasive and therefore especially useful in neonates; it is unlikely to cause stress and thus salivary cortisol values are more likely to reflect the true plasma level [14].There is good evidence from studies in older children [15] and adults that salivary cortisol concentrations correlate well with plasma cortisol concentrations at baseline/rest as well as during exercise and during dynamic function tests involving the hypothalamic-pituitary-adrenal axis [16]. These studies suggest that plasma cortisol measurement can be replaced by salivary cortisol measurement. However, few studies [17] have been reported on salivary cortisol determination in neonates and particularly, extremely premature infants.We previously reported a novel method of collecting saliva, which is effective in obtaining a good quantity of saliva to enable relia...

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Diagnostic Value of Salivary Cortisol in the CRH Stimulation Test in Premature Infants

Abstract: This study indicated that using salivary cortisol measurements for the CRH test could be a reliable method for evaluating the hypothalamic-pituitary-adrenal axis in VLBWI with gestational age of less than 29 wk.

Cited by 19 publications

References 36 publications

Salivary and serum cortisol and relation to blood pressure in infancy and early childhood in very-low-birth-weight infants

Salivary and serum cortisol and relation to blood pressure in infancy and early childhood in very-low-birth-weight infants

Relationship of Salivary and Plasma Cortisol Levels in Preterm Infants: Results of a Prospective Observational Study and Systematic Review of the Literature

Correlation of Plasma and Salivary Cortisol in Extremely Premature Infants

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