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

• Published in: Pediatric research Vol. 93; no. 3; pp. 689 - 695
• Main Authors: Lowe, Jean, Fuller, Janell F., Dempsey, Allison G., Do, Barbara, Bann, Carla M., Das, Abhik, Gustafson, Kathryn E., Vohr, Betty R., Hintz, Susan R., Watterberg, Kristi L.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-02-2023; Nature Publishing Group
• Subjects: Child; Clinical Research Article; Executive Function; Female; Hormones; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Infant, Extremely Premature; Infant, Newborn; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Pituitary-Adrenal System
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1038/s41390-022-02113-9

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.
ClinicalTrials.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.