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Published on: December 18, 2013
Salivary cortisol in preterm infants: Validation of a simple method for collecting saliva for cortisol determination
Madalynn Neu1, Mark Goldstein, Dexiang Gao
1University of Colorado Denver and Health Sciences Center, School of Nursing, 4200 E. Ninth Avenue, Box C-288, Denver, CO 80262, USA. madalynn.neu@uchsc.edu
Insights
The filter paper method offers a valid and feasible approach for collecting saliva from preterm infants, simplifying the assessment of Hypothalamic-pituitary-adrenocortical (HPA) function and stress biomarkers.
Area of Science:
- Endocrinology
- Neonatal Research
- Biomarker Analysis
Background:
- Salivary cortisol is increasingly used to study Hypothalamic-pituitary-adrenocortical (HPA) function and diurnal rhythms.
- Current saliva collection methods pose challenges for preterm infants.
- This study addresses the need for a reliable saliva collection technique in this population.
Purpose of the Study:
- To validate the filter paper method for saliva collection.
- To apply the filter paper method for collecting saliva from preterm infants.
- To examine diurnal cortisol patterns in preterm infants.
Main Methods:
- Validation involved comparing filter paper to whole saliva, assessing storage effects, spiking recovery, and linearity.
- Saliva was collected from 26 preterm infants every three hours for three days.
- Diurnal variation was analyzed using hierarchical linear modeling.
Main Results:
- The filter paper method demonstrated acceptable recovery, storage stability up to six months, and linearity.
- Saliva collection from preterm infants was feasible with minimal sample loss (2%).
- Cortisol levels showed an inverse association with postconceptional age and Apgar scores; diurnal patterns were variable.
Conclusions:
- The filter paper method is a valid and feasible technique for saliva collection in preterm infants.
- This method facilitates research into HPA function and stress in neonates.
- Further investigation into atypical diurnal cortisol patterns in preterm infants is warranted.
Background And Aims:
The increased use of salivary cortisol as a biomarker of stress and/or diurnal rhythms has facilitated research of Hypothalamic-pituitary-adrenocortical (HPA)function. Saliva collection remains problematic with preterm infants. The twofold purpose of this study is to 1) establish validity of the filter paper method for saliva collection and 2) apply the filter paper method for saliva collection to preterm infants.
Design And Measures:
Whole saliva was collected from six normal adult subjects to create a pool. Validation measures included comparison of levels obtained from whole saliva and filter paper, an evaluation of storage effects, assessing spiking recovery, and measurement of linearity of dilution. In the application study, saliva was collected every three hours, before feedings for three consecutive days from 26 hospitalized preterm infants. Diurnal variation in cortisol was examined using hierarchical linear modeling and individual calculation of diurnal pattern using an accepted technique.
Results:
Validation studies revealed acceptable recovery of whole saliva from filters, no effect of room temperature storage of filters for up to six months, and acceptable linearity of dilution up to 4. Saliva from preterm infants was easily collected. Only 2% of the samples were lost due to inadequate wetting of the filters. An inverse association was found between postconceptional age and one-minute APGAR scores and infant cortisol levels. Variable daily cortisol patterns and no discernable rhythm were found for this sample; however, four infants appeared to show atypical diurnal pattern.
Conclusions:
The filter paper method is a valid method of saliva collection that is feasible to use with preterm infants.
