Saliva cortisol diurnal variation and stress responses in term and preterm infants

David Q. Stoye, James P Boardman, Clive Osmond, Gemma Sullivan, Gillian Lamb, Gill S. Black, Natalie Z M Homer, Nina Nelson, Elvar Theodorsson, Evalotte Mörelius, Rebecca M Reynolds*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objectives: To determine if preterm birth is associated with adaptation of the hypothalamic-pituitary-adrenal (HPA) axis, and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at <28 weeks, or very preterm birth at 28-32 weeks gestation).

Design: This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured pre and post-vaccination, and in the morning and evening, at 4- months chronological age.

Setting: Infants born at a single Scottish hospital.

Participants: 45 term-born, 42 very preterm, and 16 extremely preterm infants.

Outcomes: Cortisol stress response to vaccination (post vaccination minus pre vaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values), and mean log-transformed daily cortisol.

Results: Compared to infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8nmol/L vs 13.1nmol/L, difference in means: -7.3 nmol/L, 95% CI: -14.0 to -0.6), and a flattened diurnal slope (difference in geometric means: -72.9%, 95% CI: -87.1 to -42.8). In contrast, the cortisol response to vaccination (difference in means -2.7 nmol/L, 95% CI: -7.4 to 2.0) and diurnal slope at 4-months (difference in geometric means: -33.6%, 95% CI: -62.0 to 16.0), did not differ significantly in infants born very preterm compared to infants born at term.

Conclusions: Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity, and could contribute to later metabolic and neurodevelopmental phenotypes, observed in this population.

Original languageEnglish
JournalArchives of Disease in Childhood
Publication statusPublished - 7 Mar 2022


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