Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress.
Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress.
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DOI：
10.1016/j.psyneuen.2014.09.018
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发表时间：
2015-01
影响因子：
3.7
通讯作者：
Grunau, Ruth E.
中科院分区：
文献类型：
--
作者：
Brummelte, Susanne;Chau, Cecil M. Y.;Cepeda, Ivan L.;Degenhardt, Amanda;Weinberg, Joanne;Synnes, Anne R.;Grunau, Ruth E.
关键词：
早期生活应激可改变下丘脑-垂体-肾上腺(HPA)轴功能。在新生儿重症监护期间暴露于巨大程序压力下的早产儿与足月出生的婴儿相比，皮质醇水平存在差异，但只有少数研究调查了HPA轴的编程改变是否会持续到蹒跚学步的年龄。此外，对于皮质醇的这些变化可能是什么因素造成的，人们缺乏了解。这项前瞻性队列研究检测了129名7岁的早产儿(24-32周)和足月儿(38-41周)在认知评估压力下的皮质醇谱，以及皮质醇的昼夜节律。此外，我们调查了皮质醇水平与新生儿程序疼痛相关压力(控制多种医学混杂因素)、同时存在的母性因素(育儿压力、抑郁和焦虑症状)以及儿童行为问题之间的关系。对于每个目标，我们调查了对认知挑战的急性皮质醇反应曲线，以及家中的皮质醇昼夜模式。我们假设，早产儿的皮质醇分泌模式将与足月出生的孩子不同，这可能取决于同时存在的儿童和母亲因素，以及暴露在新生儿疼痛相关的压力下将与早产儿皮质醇分泌的变化相关，可能是以性别依赖的方式。7岁儿童的唾液样本在实验室访问期间采集了三次，以评估认知和执行功能(预测、中期测试、研究结束日的急性压力曲线)，并在连续两个非上学日在家中采集了四次唾液样本(即上午、上午中段、下午和睡前-日节律曲线)。我们发现，早产儿和足月儿的皮质醇水平相似，尽管早产儿睡前皮质醇水平略高于足月儿。重要的是，在早产儿组中，较大的新生儿程序性疼痛相关压力(经吗啡调整)与研究当天较低的皮质醇水平(p=0.044)和较低的家庭皮质醇水平(p=0.023)相关，影响主要见于男孩。此外，早产儿在学习当天的认知评估中，儿童注意力问题与皮质醇反应呈负相关，而思维问题与皮质醇反应呈正相关。我们的发现表明，新生儿疼痛/应激导致早产儿在学龄前HPA轴功能改变，性别可能是一个重要因素。
Early life stress can alter hypothalamic pituitary adrenal (HPA) axis function. Differences in cortisol levels have been found in preterm infants exposed to substantial procedural stress during neonatal intensive care, compared to infants born full-term, but only a few studies investigated whether altered programming of the HPA axis persists past toddler age. Further, there is a dearth of knowledge of what may contribute to these changes in cortisol. This prospective cohort study examined the cortisol profiles in response to the stress of cognitive assessment, as well as the diurnal rhythm of cortisol, in children (n=129) born at varying levels of prematurity (24–32 weeks gestation) and at full-term (38–41 weeks gestation), at age 7 years. Further, we investigated the relationships among cortisol levels and neonatal procedural pain-related stress (controlling for multiple medical confounders), concurrent maternal factors (parenting stress, depressive and anxiety symptoms) and children’s behavioral problems. For each aim we investigate acute cortisol response profiles to a cognitive challenge as well as diurnal cortisol patterns at home. We hypothesized that children born very preterm will differ in their pattern of cortisol secretion from children born full-term, possibly depended on concurrent child and maternal factors, and that exposure to neonatal pain-related stress would be associated with altered cortisol secretion in children born very preterm, possibly in a sex-dependent way. Saliva samples were collected from 7-year old children three times during a laboratory visit for assessment of cognitive and executive functions (pretest, mid-test, end - study day acute stress profile) and at four times over two consecutive non-school days at home (i.e. morning, mid-morning, afternoon and bedtime - diurnal rhythm profile). We found that cortisol profiles were similar in preterm and full-term children, albeit preterms had slightly higher cortisol at bedtime compared to full-term children. Importantly, in the preterm group, greater neonatal procedural pain-related stress (adjusted for morphine) was associated with lower cortisol levels on the study day (p=0.044) and lower diurnal cortisol at home (p=0.023), with effects found primarily in boys. In addition, child attention problems were negatively, and thought problems were positively, associated with the cortisol response during cognitive assessment on the study day in preterm children. Our findings suggest that neonatal pain/stress contributes to altered HPA axis function up to school-age in children born very preterm, and that sex may be an important factor.
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