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Pediatr Res. 2018 Dec 12. doi: 10.1038/s41390-018-0243-1. [Epub ahead of print]

Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm.

Author information

1
University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Kwatterberg@salud.unm.edu.
2
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
3
Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA.
4
Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA.
5
University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
6
Department of Psychology, University of Denver, Denver, CO, USA.
7
Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, USA.
8
Department of Pediatrics, Wayne State University, Detroit, MI, USA.
9
Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
10
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.

Abstract

BACKGROUND:

Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children.

METHODS:

Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening).

RESULTS:

For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01).

CONCLUSION:

Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).

PMID:
30631138
DOI:
10.1038/s41390-018-0243-1

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