Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery

Taşar, Serçin; Yaman, Nur Dikmen; Bulut, İsmail; Haskılıç, Yunus Emre; Saç, Rukiye Ünsal; Şeneş, Mehmet; Taşar, Medine Aysin; Taşar, Mehmet

doi:10.1017/s1047951122001081

Cited by 4 publications

(8 citation statements)

References 17 publications

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“…Studies on the association of children with (surgically corrected) CHD and cortisol levels are rare and inconsistent. One study found differences from normal reference values regarding the diurnal variability of salivary cortisol levels in children with CHD [ 58 ], while Stonawski et al [ 51 ]—based on our own data—found no differences in diurnal cortisol release between the VSD and control group at primary school age. In adolescence, instead of salivary cortisol, which rather measures acute cortisol production and is sensitive to diurnal rhythm [ 59 ], hair cortisol values were used to enable the investigation of cumulative distress over a one-month time period [ 60 ].…”

Section: Aims Of This Studycontrasting

confidence: 53%

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Lang

Gerlach

Plank

et al. 2022

JCM

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Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6–9 years) to adolescence (10–14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times—when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients’ quality of life was increased and internalizing problems were decreased—proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

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Section: Aims Of This Studycontrasting

confidence: 53%

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Lang

Gerlach

Plank

et al. 2022

JCM

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“…43,44 Indeed, studies in infants and young children with cCHD have demonstrated that altered stress markers, measured by serum and salivary cortisol, are associated with complications during the ICU stay such as prolonged mechanical ventilation and inotrope medication and with the cardiopulmonary bypass surgery. [5][6][7] In our cohort, we found no significant association between stress markers in hair at ages 10 to 15 years and length of ICU stay following open heart surgery in infancy and other clinical variables.…”

Section: Altered Stress Markers In Early Adolescents With Cchdcontrasting

confidence: 66%

“…Several studies have suggested that high early life stress may alter the function of the HPA axis and consequently alter stress markers such as cortisol and cortisone . Indeed, studies in infants and young children with cCHD have demonstrated that altered stress markers, measured by serum and salivary cortisol, are associated with complications during the ICU stay such as prolonged mechanical ventilation and inotrope medication and with the cardiopulmonary bypass surgery …”

Section: Discussionmentioning

confidence: 99%

“…Studies have investigated the association of early life stress and cortisol levels in infants with cCHD. Altered serum and salivary cortisol levels were associated with more complicated ICU stays and differed from reference values in children undergoing open heart surgery preoperatively and postoperatively . Another study found that cortisol levels differed between children aged 3 to 5 years who had undergone infant cardiac surgery and children with cCHD who did not require surgery .…”

Section: Introductionmentioning

confidence: 98%

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Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease

von Werdt,

Binz,

O’Gorman

et al. 2024

JAMA Netw Open

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ImportanceInfants with complex congenital heart disease (cCHD) may experience prolonged and severe stress when undergoing open heart surgery. However, little is known about long-term stress and its role in neurodevelopmental impairments in this population.ObjectiveTo investigate potential differences between early adolescents aged 10 to 15 years with cCHD and healthy controls in physiological stress markers by hair analysis, executive function (EF) performance, and resilience.Design, Setting, and ParticipantsThis single-center, population-based case-control study was conducted at the University Children’s Hospital Zurich, Switzerland. Patients with different types of cCHD who underwent cardiopulmonary bypass surgery during the first year of life and who did not have a genetic disorder were included in a prospective cohort study between 2004 and 2012. A total of 178 patients were eligible for assessment at ages 10 to 15 years. A control group of healthy term-born individuals was cross-sectionally recruited. Data assessment was between 2019 and 2021. Statistical analysis was performed from January to April 2023.ExposurePatients with cCHD who underwent infant open heart surgery.Main Outcomes and MeasuresPhysiological stress markers were quantified by summing cortisol and cortisone concentrations measured with liquid chromatography with tandem mass spectrometry in a 3-centimeter hair strand. EFs were assessed with a neuropsychological test battery to produce an age-adjusted EF summary score. Resilience was assessed with a standardized self-report questionnaire.ResultsThe study included 100 patients with cCHD and 104 controls between 10 and 15 years of age (mean [SD] age, 13.3 [1.3] years); 110 (53.9%) were male and 94 (46.1%) were female. When adjusting for age, sex, and parental education, patients had significantly higher sums of hair cortisol and cortisone concentrations (β, 0.28 [95% CI, 0.12 to 0.43]; P &lt; .001) and lower EF scores (β, −0.36 [95% CI, −0.49 to −0.23]; P &lt; .001) than controls. There was no group difference in self-reported resilience (β, −0.04 [95% CI, −0.23 to 0.12]; P = .63). A significant interaction effect between stress markers and EFs was found, indicating a stronger negative association in patients than controls (β, −0.65 [95% CI, −1.15 to −0.15]; P = .01). The contrast effects were not significant in patients (β, −0.21 [95% CI, −0.43 to −0.00]; P = .06) and controls (β, 0.09 [95% CI, −0.11 to 0.30]; P = .38).Conclusions and RelevanceThis case-control study provides evidence for altered physiological stress levels in adolescents with cCHD and an association with poorer EF. These results suggest that future studies are needed to better understand the neurobiological mechanisms and timing of alterations in the stress system and its role in neurodevelopment.

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“…This finding is consistent with other published works on the matter and may explains why the determination of a clear cutoff value of cortisol levels as a surrogate biomarker for stress is notoriously elusive in the literature. A recent study on child undergoing congenital cardiac surgery have found that salivary cortisol levels can be considered a predictive indicator of anxiety on pre- and postoperative period ( 25 ) .…”

Section: Discussionmentioning

confidence: 99%

Children′s preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial

Silveira,

Alves,

Nascimento Júnior

et al. 2024

Rev. esc. enferm. USP

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Objective: The main objective of this study was to compare stress and anxiety levels in children undergoing surgical procedures with or without parental presence at induction of anesthesia by measuring salivary cortisol levels and applying the mYPAS. Method: Quasi-randomized trial with children aged 5–12 year, with ASA physical status I, II, or III, undergoing elective surgery. According to parents’ willingness, the pair were defined as accompanied or unaccompanied group. Chi-square, Fisher’s exact tests, Student’s t test, Mann-Whitney, Hodges-Lehman and Spearman’s tests were used for statistical analyzes. Results: We included 46 children; 63% were preschool children mostly accompanied by their mothers (80%). The median mYPAS score was 37.5 (quartile range, 23.4–51.6) in unaccompanied children, and 55.0 (quartile range, 27.9–65.0) in accompanied children, with an estimated median difference of +11.8 (95% CI of 0 to 23.4; p = 0.044). There were no significant differences in the mean salivary cortisol levels. Conclusion: The level of anxiety was higher in accompanied children. There were no differences in salivary cortisol levels between both groups. Brazilian Registry of Clinical Trials (ReBEC):RBR-9wj4qvy.

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Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery

Cited by 4 publications

References 17 publications

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease

Children′s preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial

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