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

doi:10.1038/s41390-022-02113-9

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

,

Pediatrics

Research output: Contribution to journal › Article › peer-review

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. 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.

Original language	English
Journal	Pediatric Research
DOIs	https://doi.org/10.1038/s41390-022-02113-9
State	Accepted/In press - 2022

Bibliographical note

Funding Information:
The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for the Neonatal Research Network’s Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort through cooperative agreements. While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1038/s41390-022-02113-9

Cite this

@article{7c4a87f6fe4249fb97e7f4fbd973ea18,

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

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. 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.",

author = "Jean Lowe and Fuller, {Janell F.} and Dempsey, {Allison G.} and Barbara Do and Bann, {Carla M.} and Abhik Das and Gustafson, {Kathryn E.} and Vohr, {Betty R.} and Hintz, {Susan R.} and Watterberg, {Kristi L.} and Jobe, {Alan H.} and Caplan, {Michael S.} and Polin, {Richard A.} and Laptook, {Abbot R.} and Hensman, {Angelita M.} and Elisa Vieira and Emilee Little and Katharine Johnson and Barbara Alksninis and Keszler, {Mary Lenore} and Knoll, {Andrea M.} and Leach, {Theresa M.} and McGowan, {Elisabeth C.} and Watson, {Victoria E.} and Walsh, {Michele C.} and Fanaroff, {Avroy A.} and Allison Payne and Wilson-Costello, {Deanne E.} and Newman, {Nancy S.} and Siner, {Bonnie S.} and Arlene Zadell and Julie DiFiore and Monika Bhola and Friedman, {Harriet G.} and Gulgun Yalcinkaya and Goldberg, {Ronald N.} and Cotten, {C. Michael} and Gustafson, {Kathryn E.} and Goldstein, {Ricki F.} and Patricia Ashley and Auten, {Kathy J.} and Fisher, {Kimberley A.} and Foy, {Katherine A.} and Freedman, {Sharon F.} and Lohmeyer, {Melody B.} and Malcolm, {William F.} and Wallace, {David K.} and Carlton, {David P.} and Stoll, {Barbara J.} and Ira Adams-Chapman",

note = "Funding Information: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for the Neonatal Research Network{\textquoteright}s Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort through cooperative agreements. While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.",

year = "2022",

doi = "10.1038/s41390-022-02113-9",

language = "English",

}

TY - JOUR

T1 - Cortisol awakening response and developmental outcomes at 6–7 years in children born extremely preterm

AU - Lowe, Jean

AU - Fuller, Janell F.

AU - Dempsey, Allison G.

AU - Do, Barbara

AU - Bann, Carla M.

AU - Das, Abhik

AU - Gustafson, Kathryn E.

AU - Vohr, Betty R.

AU - Hintz, Susan R.

AU - Watterberg, Kristi L.

AU - Jobe, Alan H.

AU - Caplan, Michael S.

AU - Polin, Richard A.

AU - Laptook, Abbot R.

AU - Hensman, Angelita M.

AU - Vieira, Elisa

AU - Little, Emilee

AU - Johnson, Katharine

AU - Alksninis, Barbara

AU - Keszler, Mary Lenore

AU - Knoll, Andrea M.

AU - Leach, Theresa M.

AU - McGowan, Elisabeth C.

AU - Watson, Victoria E.

AU - Walsh, Michele C.

AU - Fanaroff, Avroy A.

AU - Payne, Allison

AU - Wilson-Costello, Deanne E.

AU - Newman, Nancy S.

AU - Siner, Bonnie S.

AU - Zadell, Arlene

AU - DiFiore, Julie

AU - Bhola, Monika

AU - Friedman, Harriet G.

AU - Yalcinkaya, Gulgun

AU - Goldberg, Ronald N.

AU - Cotten, C. Michael

AU - Gustafson, Kathryn E.

AU - Goldstein, Ricki F.

AU - Ashley, Patricia

AU - Auten, Kathy J.

AU - Fisher, Kimberley A.

AU - Foy, Katherine A.

AU - Freedman, Sharon F.

AU - Lohmeyer, Melody B.

AU - Malcolm, William F.

AU - Wallace, David K.

AU - Carlton, David P.

AU - Stoll, Barbara J.

AU - Adams-Chapman, Ira

N1 - Funding Information: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for the Neonatal Research Network’s Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort through cooperative agreements. While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Publisher Copyright: © 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

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U2 - 10.1038/s41390-022-02113-9

DO - 10.1038/s41390-022-02113-9

M3 - Article

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AN - SCOPUS:85148017935

SN - 0031-3998

JO - Pediatric Research

JF - Pediatric Research

ER -

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

Abstract

Bibliographical note

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