Maturity of the Adrenal Cortex in Very Preterm Infants Is Related to Gestational Age

Bolt, R. J.; Weissenbruch, Mirjam M. van; Popp-Snijders, C.; Sweep, Fred; Lafeber, Harry N; Waal, Henriëtte A. Delemarre-van de

doi:10.1203/00006450-200209000-00017

Cited by 62 publications

(37 citation statements)

References 41 publications

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“…Clinical studies have reported adrenal insufficiency in the neonatal period in some preterm infants born at very low gestational ages (e.g. Watterberg and Scott, 1995;Bolt et al, 2002;Ng et al, 2004;see Watterberg, 2004 for a review). Whether the cortisol difference between preterm and full-term infants reflects delayed maturation in normal development or prolonged alterations in the early programming of the hypothalamic-pituitaryadrenal (HPA) axis are unclear.…”

Section: Discussionmentioning

confidence: 99%

Cortisol, contingency learning, and memory in preterm and full-term infants

Haley

Weinberg

Grunau

2006

Psychoneuroendocrinology

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SummaryCortisol plays an important role in learning and memory. An inverted-U shaped function has been proposed to account for the positive and negative effects of cortisol on cognitive performance and memory in adults, such that too little or too much impair but moderate amounts facilitate performance. Whether such relationships between cortisol and mental function apply to early infancy, when cortisol secretion, learning, and memory undergo rapid developmental changes, is unknown. We compared relationships between learning/memory and cortisol in preterm and full-term infants and examined whether a greater risk for adrenal insufficiency associated with prematurity produces differential cortisol-memory relationships. Learning in three-month old (corrected for gestational age) preterm and full-term infants was evaluated using a conjugate reinforcement mobile task. Memory was tested by repeating the same task 24 h later. Salivary cortisol samples were collected before and 20 min after the presentation of the mobile. We found that preterm infants had lower cortisol levels and smaller cortisol responses than full-term infants. This is consistent with relative adrenal insufficiency reported in the neonatal period. Infants who showed increased cortisol levels from 0 to 20 min on Day 1 had significantly better memory, regardless of prematurity, than infants who showed decreased cortisol levels.

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Section: Discussionmentioning

confidence: 99%

Cortisol, contingency learning, and memory in preterm and full-term infants

Haley

Weinberg

Grunau

2006

Psychoneuroendocrinology

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“…Another mechanism contributing to RAI is the immaturity of adrenal cortex enzymes, notably decreased 11β-hydroxylase activity, which is necessary for the conversion of 11-deoxycortisol to cortisol [13,14]. Furthermore, there is some evidence suggesting that the interconversion between cortisol and cortisone, by 11β-HSD isozymes in peripheral tissues, favors cortisone with decreasing gestational age [15]. …”

Section: Relative Adrenal Insufficiencymentioning

confidence: 99%

Programming of the Hypothalamus-Pituitary-Adrenal Axis by Very Preterm Birth

et al. 2017

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Background: Many very preterm (i.e., <32 weeks of gestation) newborns fail to mount an adequate adrenocortical response to stress or illness, termed relative adrenal insufficiency. Conversely, later in life these infants show features of increased glucocorticoid bioactivity, such as abdominal adiposity, insulin resistance, raised blood pressure, shorter stature and internalizing problem behavior. Summary: Studies suggested that very preterm newborns have impairments along multiple levels of the hypothalamus-pituitary-adrenal (HPA) axis. Among the impairment were defects in: (1) the pituitary responsiveness to exogenous corticotropin-releasing hormone, (2) 11β-hydroxylase activity, and (3) the interconversion between cortisol and inert cortisone. There is some evidence suggesting that later in life these infants have an increased basal secretion rate of cortisol and adrenal hyperandrogenism. However, the response to acute (psychosocial) stress was blunted rather than enhanced in them. The mechanisms explaining this switch in HPA axis activity are complex and not yet fully understood. Key Messages: Very preterm newborns have several impairments along the HPA axis that could impede an adequate adrenocortical response to stress or illness. Later in life, these infants are predisposed to increased HPA axis activity, which could partially explain their phenotype.

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“…Moreover, sleep time increased in relation to CCR development at PNA week eight among preterm infants [70]. The observed lack of correlation between CCR and behavioral regularity may be because CCR depends on maturity of biological functions such as maturation of the adrenal cortex and other developmental functions that accompany increased GA [29], whereas regularity in behaviors such as sleep seems to be dependent on both GA and environmental influences, e.g. days at home or in hospital care [192].…”

Section: Possible Correlation Between Behavioral Regularity and Cortimentioning

confidence: 99%

“…Preterm infants are a heterogeneous group with highly varied needs regarding level of neonatal care and medical treatment, depending on factors such as GA, pregnancyrelated circumstances and/or various complications. Proper development of the hypothalamic-pituitary-adrenal (HPA) axis and cortisol secretion are essential for lung maturation at birth, and cortisol levels increase in tandem with increasing GA [29][30][31].…”

Section: The Preterm Infantmentioning

confidence: 99%

“…CCR at one month CA in preterm infants resembles CCR at one month PNA in full-term infants (paper I). Maturation of the adrenal cortex in preterm infants relates to GA [29] and GA in preterm infants predicts perinatal morbidity, delayed maturation of lung function, and state of health, as well as illness and concentration difficulties later in life [29-31, 158, 190].…”

Section: Development Of Cortisol Circadian Rhythm Dependent On Gestatmentioning

confidence: 99%

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Stress : Clinical and Developmental Aspects of Salivary Cortisol in Infants

Ivars¹

2016

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A functional stress-response system is essential for survival at birth, as well as for health and further development. Altered cortisol response and hypothalamic-pituitary-adrenal system function may have both short and long-term effects on health and development throughout life. Cortisol secretion follows a circadian rhythm in adults. Data in the literature concerning basal cortisol levels is scant, with divergent results regarding the timeframe for establishment of cortisol circadian rhythm in children. Nevertheless, cortisol is often studied in stress-related research concerning preterm infants, full-term infants, and infants at high psychosocial risk. This thesis aimed to investigate at what age cortisol circadian rhythm develops in healthy full-term infants, preterm infants, and infants at high psychosocial risk and to identify whether such development is dependent on gestational or postnatal age. A secondary aim was to investigate whether either behavioral regularity or daily life trauma are associated with establishment of cortisol circadian rhythm. The last two interventional studies explored whether a) parental participation in the Hagadal daycare attachment program in one study and b) oral administration of glucose during nasopharyngeal suctioning in the other study influenced development of salivary cortisol circadian rhythm and/or cortisol levels. The effects, if any, of the Hagadal daycare attachment program on caregiver sensitivity to infants were also investigated. The present thesis includes four original studies. Papers I, II, and III describes prospective, longitudinal studies extending over a year, including a survey of the cortisol levels and development of cortisol circadian rhythm in three infant groups. Paper III also included an intervention component addressing the possible effects of the Hagadal daycare attachment program. Paper IV describes a case-control study designed to generate paired baseline-response data concerning the effects of oral glucose administration during nasopharyngeal suctioning as an interventional procedure. Cortisol circadian rhythm in salivary cortisol secretion was similarly established at one month postnatal age in full-term infants and at one month corrected age in preterm infants, reflecting a process dependent on gestational age. This rhythm persisted throughout the first year of life in all infants and consolidated over time in healthy full-term and preterm infants, but not in infants at high psychosocial risk, who displayed higher variability in cortisol levels. The infants in paper IV had not yet reached one month of corrected age and therefore had not yet developed cortisol circadian rhythm at the time of the investigation. No correlation was found between development of cortisol circadian rhythm and either behavioral regularity or reported traumatic life events. This thesis presents data on salivary cortisol levels among three different groups of infants during the first year of life. Cortisol circadian rhythm among infants in study III evolved in respon...

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Maturity of the Adrenal Cortex in Very Preterm Infants Is Related to Gestational Age

Cited by 62 publications

References 41 publications

Cortisol, contingency learning, and memory in preterm and full-term infants

Cortisol, contingency learning, and memory in preterm and full-term infants

Programming of the Hypothalamus-Pituitary-Adrenal Axis by Very Preterm Birth

Stress : Clinical and Developmental Aspects of Salivary Cortisol in Infants

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