Hair Cortisol as a Potential Biologic Marker of Chronic Stress in Hospitalized NeonatesYamada J.c · Stevens B.a, c · de Silva N.c, d · Gibbins S.b, d · Beyene J.c · Taddio A.c, e · Newman C.f · Koren G.c, f
aFaculties of Nursing and Medicine, University of Toronto, bSunnybrook & Women’s College Health Sciences Centre, and cResearch Institute, dNeonatology, ePharmacy Research, and fClinical Pharmacology and Toxicology, The Hospital for Sick Children (SickKids), Toronto, Ont., Canada
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Background: As preterm and term infants in the neonatal intensive care unit (NICU) undergo multiple stressful/painful procedures, research is required that addresses chronic stress. Objectives: To determine whether (a) hair cortisol levels differed between term and preterm infants exposed to stress in the NICU and (b) an association exists between hair cortisol levels and severity of illness or indicators of acute stress. Methods: Hair cortisol levels were determined using the ELISA method (solid-phase enzyme-linked immunoassay, Alpco Diagnostics, Windham, N.H., USA) in 60 infants >25 weeks gestational age at birth. Results: No significant differences were found between the hair cortisol levels of term infants compared to preterm infants in the NICU. When compared to a group of healthy term infants, hospitalized infants had significantly higher hair cortisol levels (t (76) = 2.755, p = 0.004). A subgroup analysis of the term NICU infants showed a statistically significant association between total number of ventilator days and hair cortisol levels. For every extra day on the ventilator, hair cortisol levels increased on average by 0.2 nmol/g (p = 0.03). 21% of the variance in hair cortisol levels was explained by the total number of days on the ventilator. Conclusions: Hair cortisol is influenced by days of ventilation in NICU term infants. This is a potentially valid outcome for chronic neonatal stress in these infants and warrants further investigation.
© 2007 S. Karger AG, Basel
Barker DP, Rutter N: Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed 1995;72:F47–F48.
Grunau R: Long-term consequences of pain in human neonates; in Anand KJ, Stevens B, McGrath PJ (eds): Pain in Neonates, 2nd rev enlarged ed. Amsterdam, Elsevier Science, 2000, pp 55–77.
- Peters KL: Neonatal stress reactivity and cortisol. J Perinat Neonatal Nurs 1998;11:45–59.
- Taddio A, Katz J: The effects of early pain experience in neonates on pain responses in infancy and childhood. Paediatr Drugs2005;7:245–257.
- Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, McKeever P, O’Brien K, Ohlsson A, Yamada J: Procedural pain in newborns at risk for neurologic impairment. Pain 2003;105:27–35.
- Giannakoulopoulos X, Sepulveda W, Kourtis P, Glover V, Fisk NM: Fetal plasma cortisol and β-endorphin response to intrauterine needling. Lancet 1994;344:77–81.
Plotsky PM, Bradley CC, Anand KJ: Behavioral and neuroendocrine consequences of neonatal stress; in Anand KJ, Stevens B, McGrath PJ (eds): Pain in Neonates, 2nd rev enlarged ed. Amsterdam, Elsevier Science, 2000, pp 77–101.
- Kurzner SI, Garg M, Bautista B, Bader, DB, Merritt RJ, Sargent CW, Bowman CM, Keens TG: Growth failure in bronchopulmonary dysplasia: elevated metabolic rates and pulmonary mechanics. J Pediatr 1988;112:73–80.
- Goldman RD, Koren G: Biologic markers of pain in the vulnerable infant. Clin Perinatol2002:29:415–425.
Arbring K, Nelson N: Cortisol response to heelstick stressor in preterm infants. Prenat Neonat Med2000;5:182–185.
Barker DP, Rutter N: Stress, severity of illness, and outcome in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996;75:F187–F190.
- Economou G, Andronikou S, Challa A, Cholevas V, Lapatsanis PD: Cortisol secretion in stressed babies during the neonatal period. Horm Res1993;40:217–221.
- Hanna CE, Jett PL, Laird MR, Mandel SH, LaFranchi SH, Reynolds JW: Corticosteroid binding globulin, total serum cortisol, and stress in extremely low-birth-weight infants. Am J Perinatol 1997;14:201–204.
- Schmidt NA: Salivary cortisol testing in children. Issues Compr Pediatr Nurs 1998;20:183–190.
- Gunnar MR: Reactivity of the hypothalamic-pituitary-adrenocortical system to stressors in normal infants and children. Pediatrics 1992;90:491–497.
Klein J, Karaskov T, Koren G: Clinical applications of hair testing for drugs of abuse – the Canadian experience.Forensic Sci Int 2000;107:281–288.
- Cirimele V, Kintz P, Dumestre V, Goulle JP, Ludes B: Identification of ten corticosteroids in human hair by liquid chromatography-ionspray mass spectrometry. Forensic Sci Int2000;107:381–388.
- Nakahara Y: Hair analysis for abused and therapeutic drugs. J Chromatogr B Biomed Sci Appl1999;733:161–180.
Saitoh M, Uzuka M, Sakamoto M: Rate of hair growth; in Montagna W, Dobson RL (eds): Advances of Biology of Skin. Oxford, Profman, 1969, pp 183–201.
- Furdon SA, Clark DA: Scalp hair characteristics in the newborn infant. Adv Neonatal Care 2003;3:286–296.
- Ito N, Ito T, Kromminga A, Bettermann A, Takigawa M, Kees F, Straub RH, Paus R: Human hair follicles display a functional equivalent of the hypothalamic-pituitary-adrenal axis and synthesize cortisol? FASEB J 2005;19:1332–1334.
- Davenport M, Tiefenbacher S, Lutz CK, Novak MA, Meyer JS: Analysis of endogenous cortisol concentrations in the hair of rhesus macaques. Gen Comp Endocrinol 2006;147:255–261.
Friedman LS, Pee D: Return to note on screening regression equations. Am Stat 1989;43:279–282.
- Raul JS, Cirimele V, Ludes B, Kintz P: Detection of physiological concentrations of cortisol and cortisone in human hair. Clin Biochem 2004;37:1105–1111.
- Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldman DA: Neonatal Therapeutic Intervention Scoring System: a therapeutically based severity of illness. Pediatrics 1992;90:561–567.
Richardson DK, Escobar GJ: Simplified and revalidated score for neonatal acute physiology (SNAP-11) maintains excellent predictive performance. Pediatr Res 1998;43:227A.
- Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA: Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics1993;91:617–623.
- Stevens B, Johnston C, Franck L, et al: The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res 1999;48:35–43.
- Gibbins S, Stevens B, Hodnett E, et al: Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 2002;51:375–382.
- Cullen DJ, Civetta JM, Briggs BA, Ferrara LC: Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med1974;2:57–60.
- Richardson DK, Corcoran JD, Escobar GJ, Lee SK: SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr2001;138:92–100.
- Yang HZ, Lan J, Meng YJ, Wan XJ, Han DW: A preliminary study of steroid reproductive hormones in human hair. J Steroid Biochem Mol Biol 1998;67:447–450.
- Stokowski LA: A primer on apnea of prematurity. Adv Neonatal Care 2005;5:155–174.
- Grunau RE, Holsti L, Haley DW, Oberlander T, Weinbert J, Solimano A, Whitfield MF, Fitzgerald C, Yu W: Neonatal procedural pain exposure predicts lower cortisol and behavioural reactivity in preterm infants in the NICU. Pain2005;113:293–300.
Oberlander T: Biomarkers of pain reactivity in neonates; in Changing the Face of Pediatric Pain: 24th Annual Scientific Meeting of the American Pain Society, March 2005. Boston, American Pain Society, 2005, pp 1–11.
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