Cortisol awakening response and developmental outcomes at 6-7 years in children born extremely preterm

Authors

Jean Lowe, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Janell F. Fuller, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Allison G. Dempsey, Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
Barbara Do, Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
Carla M. Bann, Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
Abhik Das, Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
Kathryn E. Gustafson, Department of Pediatrics, Duke University, Durham, NC, USA
Betty R. Vohr, Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
Susan R. Hintz, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
Kristi L. Watterberg, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
SUPPORT NEURO School-Age Study Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Document Type

Article

Publication Date

6-17-2022

Abstract

BACKGROUND: Extremely preterm (EPT) birth has been related to dysregulation of stress responses and behavioral/learning problems at school age. Early adverse experiences can blunt HPA axis reactivity. We hypothesized that an attenuated cortisol awakening response would be associated with developmental and behavioral problems at school age in EPT children.

METHODS: This secondary analysis of a sub-cohort of the SUPPORT study included children born between 24 and 27 weeks, evaluated at 6-7 years with a neurodevelopmental battery and cortisol measures. Differences were tested between EPT and a term-born group. Relationships of cortisol awakening response to test scores were analyzed.

RESULTS: Cortisol was measured in 110 EPT and 29 term-born 6-7 year olds. Unadjusted WISC-IV and NEPSY-II scores were significantly worse among EPT children only. Conners Parent Rating Scale behavior scores were significantly worse among EPT children. After adjusting for covariates, blunted cortisol awakening responses were found to be associated with poorer scores on memory tests and greater problems with inattention for the EPT group (p < 0.05) only.

CONCLUSIONS: Among children born EPT, we identified an association of blunted cortisol awakening response with memory and inattention problems. This may have implications related to stress reactivity and its relationship to learning problems in children born EPT.

GOV ID: Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324.

IMPACT: In children born EPT, stress reactivity may have a relationship to learning problems. Cortisol awakening response should be a component for follow-up in EPT born children. Components of executive function, such as memory and attention, are related to stress reactivity.

Publisher

Lippincott Williams & Wilkins

Publication Title

Pediatric research

ISSN

1530-0447

DOI

10.1038/s41390-022-02113-9

Recommended Citation

Lowe J, Fuller JF, Dempsey AG, Do B, Bann CM, Das A, Gustafson KE, Vohr BR, Hintz SR, Watterberg KL; SUPPORT NEURO School-Age Study Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Cortisol awakening response and developmental outcomes at 6-7 years in children born extremely preterm. Pediatr Res. 2022 Jun 17. doi: 10.1038/s41390-022-02113-9. Epub ahead of print. PMID: 35715492.