Noninvasive surrogate markers for plasma cortisol in newborn infants: utility of urine and saliva samples and caution for venipuncture blood samples (original) (raw)
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Correlation of Plasma and Salivary Cortisol in Extremely Premature Infants
Journal of Neonatal Biology, 2017
Background: In the neonatal period, cortisol concentrations are expected to increase during significant stress and are important for survival. Extreme preterm infants may develop adrenal insufficiency in the early neonatal period. Cortisol is 90% bound to cortisol binding globulins (CBG) in the circulation; therefore measurements of plasma cortisol can be compromised by conditions that alter CBG levels. Measurement of free cortisol is the best indicator of adrenal glucocorticoid secretion and can be determined in the saliva. Few studies have been reported on salivary cortisol determination in the neonatal period and particularly, extremely premature infants. Methods: There were 65 infants (36 males). Mean gestation 25.3 ± 1.3 weeks. We obtained early morning plasma and salivary cortisol sampling before day 5 of postnatal age from extremely premature babies less than 28 weeks gestation. Saliva was obtained using 4 standard universal swabs by placing one swab at a time in the infant's mouth for 1-2 min. No salivary stimulants were used. Salivary cortisol was measured by competitive ELISA using a commercially available kit SLV-2930 (DRG, Germany) according to the manufacturer's instructions. Plasma cortisol was measured using DPC Immulite2000 using a solid phase 2 site chemiluminescent immunometric assay. Results: Mean plasma cortisol levels were 400 nmol/L ± 42.8 SEM, and mean salivary cortisol levels were 127.5 nmol/L ± 66.5 SEM. Plasma cortisol was positively correlated with salivary cortisol (r=0.41, p<0.001). Conclusion: The study showed a reasonable correlation between salivary and plasma cortisol concentrations obtained early in the morning in the extremely preterm infants.
Salivary and serum cortisol levels in newborn infants
Archivos argentinos de pediatria, 2017
Given that serum cortisol level interpretation in newborn infants (NBIs) is hard, the objective of this study was to correlate baseline salivary and serum cortisol levels and to describe salivary cortisol levels in the first month of life. Descriptive, prospective, longitudinal, and correlational study. Term NBIs were selected from the Division of Neonatology of Hospital Nacional Profesor Alejandro Posadas in 2014. Cortisol was measured in saliva specimens while cortisol, cortisol-binding globulin, and albumin were measured in blood specimens. A linear correlation was performed to relate serum and salivary cortisol levels; Friedman test was conducted to compare cortisol levels during the first month of life, and the difference was used to analyze the performance of values equal to or lower than the first quartile. Fifty-five NBIs were studied. Serum cortisol: 7.65 (1.0-18.1 gg/dL); salivary cortisol: 35.88 (5.52-107.64 mmol/L); cortisol-binding globulin: 22.07 (16.5-33.0 gg/mL), exp...
Salivary cortisol measurements in sick infants: A feasible and objective method of measuring stress?
Journal of Neonatal Nursing, 2005
To investigate the utility of salivary cortisol as an objective measure of stress in sick infants. Participants: One hundred and forty four infants nursed in two neonatal intensive care units in two children's hospitals in Australia. Design: A prospective observational cohort study. Methods: Infants' saliva was collected using a 3 mL syringe attached to a shortened size 8 FG feeding tube. Salivary cortisol levels were measured using ELISA and examined for associations with potential environmental stressors in the NICU. Main outcome measures: 1. collection of saliva in sufficient volumes for analysis, 2. relationship between salivary cortisol levels and environmental factors associated with stress.
Urinary Free Cortisol (UFC) Values in Newborns Under Stress
Journal of Pediatric Endocrinology and Metabolism, 1999
Children with adrenocortical insufficiency are commonly instructed to increase three to five times baseline glucocorticoid replacement dose during periods of stress such as surgery or febrile illness. The present study was undertaken to determine whether these recommendations reflect the actual change in urinary free Cortisol (UFC) output during stress in neonates and to test the effect of stress on the diurnal variation of Cortisol in this age group. Design and patients: Twenty-four hour urinary free Cortisol (UFC) excretion was determined in 75 neonates during the first 2 days of life. Thirty were healthy and 45 were neonates with respiratory distress. In 60 babies the 24-h UFC was collected in 6-h fractions for the determination of diurnal variation of urinary Cortisol. Results: The mean change in UFC was 4.5 times higher in the sick babies than in the controls. A distinct diurnal variation of UFC was noted in both healthy and sick babies. Conclusions: In contrast with previous publications a distinct diurnal pattern was noted in the majority of neonates.
The Cortisol Serum Measurement as a Marker of Stress in Neonates
International Journal of Sciences: Basic and Applied Research, 2018
The first few days of life are crucial; the neonates are particularly vulnerable to stress and infection during this period. Stress can cause changes in metabolic and endocrine, including cortisol level. The disease causes an indirect impact on cortisol level through cytokines and enzymes. Elevation of cortisol level can disturb hemostasis and cause long terms complications. This research aimed to compare the difference in cortisol level between healthy and neonatal with high suspicion of sepsis. The study was an observational study using the cross-sectional method, conducted in Ananda mother and child hospital Makassar, from February until April 2018. Sixty neonates who fulfill the criteria were included in the study. They were divided into control group (CG) and patient group (PG). The blood samples in CG were taken a right after birth before the routine procedure was performed. Meanwhile, blood samples in PG were made at the time of diagnosis. The level of serum cortisol was meas...
Serum cortisol concentrations in ill preterm infants less than 30 weeks gestational age
Acta Paediatrica, 2007
Adrenal insufficiency is suspected in some ill preterm infants. The aim of this prospective study was to compare serum cortisol concentrations during the first 2 wk of life of well preterm infants (group A) less than 30 wk of gestational age with the cortisol concentrations of ill preterm infants whose arterial hypotension-a potential sign of adrenal insufficiency-had been treated with catecholamine (group B), and the cortisol concentrations of ill preterm infants who had not been so treated (group C). Cortisol concentrations did not differ significantly between group A (240 nrnol/l, 58-659; n = 46) (median, minimum-maximum) and group C (268 nmolfi, 58-1007; n=25). Group B had a double-peaked distribution of cortisol. Two subgroups were formed by taking the highest cortisol level of group A as a threshold: group B 1 (1 10 nmoV1, 41-378; n = 20) and group B2 (1200 nmolll, 764-1482; n = 8). The cortisol concentrations of group B 1 were significantly Iower (p = 0.00097) compared to the cortisol concentrations of the well preterm infants (group A). The seventy of illness, which was quantified by two scoring systems, differed significantly among the groups 0, < 0.003 for all comparisons) with the following sequence: A < C < B, but not between B1 and B2, as clinical variables were not different between the subgroups.
Determination of reference values for salivary cortisol in healthy infants aged 0-12 months
Archivos Argentinos de Pediatria
Introduction. Salivary cortisol is a useful tool as a biomarker of stress in pediatrics because it allows for non-invasive sampling. There is little information about its use in children, and no reference values for healthy infants have been reported in Argentina. Reference values should be established at each site as the basis for subsequent tests in infants, for whom salivary cortisol appears to be the most relevant objective tool to assess stress at present. Objective. To determine reference values for salivary cortisol in healthy infants aged 0-12 months. Methods. Descriptive, cross-sectional study that assessed morning salivary cortisol levels in healthy male and female infants aged 0-12 months that attended Hospital Pirovano for a health checkup between March 2017 and March 2018. Fasting saliva samples were collected between 8 and 9 a.m. and were processed using electrochemiluminescence. Results were reported as mean and standard deviation. Results. A total of 140 infants were included, and 96 samples were collected. Mean morning salivary cortisol levels were 5.46 nmol/L (95 % confidence interval: 4.66-6.38), standard deviation: 2.15. No correlation to age was observed, so it was not necessary to divide the reference range into age groups. No significant differences were observed in terms of sex, gestational age, birth weight, type of delivery or type of feeding. Conclusion. The reference range of morning salivary cortisol levels in healthy infants aged 0-12 months was reported.
Acta paediatrica (Oslo, Norway : 1992), 2015
Neonatal therapy-resistant septic shock is a common problem in middle and low-income countries. We investigated whether newborn infants with infection and therapy-resistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors. A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution. Serum was obtained during days four and 14 after birth. Cortisol and cortisol precursor concentrations were analysed using liquid chromatography-tandem mass spectrometry. The cortisol concentrations were low considering the expected responses to stress and they did not differ between the groups. The infants with infection and shock had higher serum dehydroepiandrosterone (DHEA) levels than those without shock (319.0±110....