The hormonal and metabolic response to stress in the neonate

Schmeling, David J.; Coran, Arnold G.

doi:10.1007/bf00177096

Cited by 13 publications

(7 citation statements)

References 150 publications

(162 reference statements)

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“…Associations between acyl-carnitines and sepsis have been previously documented, with heightened analyte levels occurring among septic infants 35,36 and positive correlations being reported between certain acyl-carnitine levels and 28-day mortality 37 . High acyl-carnitine levels have also been reported in other cases of injury 35 and catabolic stress, which is likely the mechanism of their association with neonatal sepsis 38–40 . In cases of stress, fatty acid oxidation is disrupted, resulting in higher levels of circulating acyl-carnitines 36 .…”

Section: Discussionmentioning

confidence: 87%

Using newborn screening analytes to identify cases of neonatal sepsis

Fell

Hawken

Wong

et al. 2017

Sci Rep

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Neonatal sepsis is associated with high mortality and morbidity, yet challenges with available diagnostic approaches can lead to delays in therapy. Our study assessed whether newborn screening analytes could be utilized to identify associations with neonatal sepsis. We linked a newborn screening registry with health databases to identify cases of sepsis among infants born in Ontario from 2010–2015. Correlations between sepsis and screening analytes were examined within three gestational age groups (early preterm: <34 weeks; late preterm: 34–36 weeks; term: ≥37 weeks), using multivariable logistic regression models. We started with a model containing only clinical factors, then added groups of screening analytes. Among 793,128 infants, 4,794 were diagnosed with sepsis during the neonatal period. Clinical variables alone or in combination with hemoglobin values were not strongly predictive of neonatal sepsis among infants born at term or late preterm. However, model fit improved considerably after adding markers of thyroid and adrenal function, acyl-carnitines, and amino acids. Among infants born at early preterm gestation, neither clinical variables alone nor models incorporating screening analytes adequately predicted neonatal sepsis. The combination of clinical variables and newborn screening analytes may have utility in identifying term or late preterm infants at risk for neonatal sepsis.

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Section: Discussionmentioning

confidence: 87%

Using newborn screening analytes to identify cases of neonatal sepsis

Fell

Hawken

Wong

et al. 2017

Sci Rep

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“…It has been claimed that ACTH and the endorphins play a role in the responses to var ious stresses, including pain, surgery [1][2][3][4], hypoxia and respiratory difficulties [5,6], even in neonates. ACTH, P-endorphin (P-E) and p-lipotropin originate from a common pituitary precursor, proopiomelanocortin, implying a concomitant corticotropin releas ing factor, mediating control of the pituitary secretion of these hormones in stressful situa-tions [7][8][9], ACTH in turn stimulates the pro duction of cortisol, which is an important fac tor for protecting the organism from stress, in that it acts synergistically with catechol amines [10].…”

Section: Introductionmentioning

confidence: 99%

Effect of Opioid-lnduced Analgesia on β-Endorphin, Cortisol and Glucose Responses in Neonates with Cardiorespiratory Problems

Pokela

1993

Neonatology

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The effects of analgesia on plasma β-endorphin (β-E), serum cortisol and blood glucose responses were investigated in 20 distressed, mechanically ventilated neonates during the first 3 days of life. Morphine 0.1 mg/kg, meperidine 1 mg/kg or alfentanil 10 µg/kg were used for analgesia as clinically indicated. Plasma β-E, serum cortisol and blood glucose were recorded before analgesia and 1 and/or 2, 12 and 24 h afterwards in the distress group and once in 20 healthy neonates (control group). β-E, cortisol, and blood glucose before analgesia were significantly higher in the distress group than in the control group. Cortisol values had decreased significantly 2 h after analgesia and blood glucose within 12 h. Plasma β-E values had decreased to the same level as in the controls 24 h after the start of analgesia. The results indicate that the stress response in the distressed neonates with cardiorespiratory problems, as assessed by β-E, cortisol, and blood glucose, is attenuated by opioid medication, and it is concluded that these patients should be given adequate analgesia.

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“…We need to develop more widely accepted end points of behaviour and physiology that can be used in real time by staff (possibly automatically aquired and on line to the infant monitors) and these need to take account of maturity. We also need to develop micromethods for the neurochemicals involved in pain and stress that ethically allow repeated measurement -it may then be possible to use these as a gold standard reference for research.The magnitude of the problem is large compared to the size of the infants and the repertoire of their responses but data indicating metabolic stress reviewed by Schmeling and Coran [61] and increased mortality when the subject is ignored would predicate its importance [3].…”

Section: Future Development Of a Pain And Sedation Scorementioning

confidence: 98%

Pain in the newborn, a possible new starting point

McIntosh

1997

Eur J Pediatr

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Pain is not a subjective experience, it is, particularly in children, an emotional issue. The formation of the International Association for the Study of Pain (IASP) in 1973 injected some standards and objectivity into the subject which allowed investigators around the world to probe both the underlying scientific basis of pain and nociception (nociception being the noxious sensation per se with no regard to the emotional experience). At the same time therapeutic strategies for different clinical problems have been evaluated, putting pain management on a scientifically secure and more individually effective basis. Self report has been the 'gold standard' of pain measurement but even in co-operative adults this has inherent weaknesses/biases related to the person and their situation (both the feelings and the reporting of pain are context sensitive). In some clinical areas, subject report is clearly impossible e.g. the psychogeriatric population, the mentally retarded and in preverbal children. However, even in these groups, there are usually behavioural responses to acute pain that are reasonably interpretable by their caregivers.

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The hormonal and metabolic response to stress in the neonate

Cited by 13 publications

References 150 publications

Using newborn screening analytes to identify cases of neonatal sepsis

Using newborn screening analytes to identify cases of neonatal sepsis

Effect of Opioid-lnduced Analgesia on β-Endorphin, Cortisol and Glucose Responses in Neonates with Cardiorespiratory Problems

Pain in the newborn, a possible new starting point

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