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Effect of stress on the hypothalamic-pituitary-adrenal axis in the fetus and newborn

Pak Cheung Ng1

  • 1Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China. pakcheungng@cuhk.edu.hk

The Journal of Pediatrics
|January 18, 2011
PubMed

Insights

The hypothalamic-pituitary-adrenal (HPA) axis in preterm infants adapts quickly, with most showing adequate stress response by day 14. An attenuated cortisol response may protect against intracranial bleeding in these vulnerable newborns.

Area of Science:

  • Endocrinology
  • Neonatal Physiology
  • Perinatal Medicine

Background:

  • The hypothalamic-pituitary-adrenal (HPA) axis is crucial for fetal and newborn homeostasis.
  • Extremely preterm infants can experience transient adrenocortical insufficiency.
  • The HPA axis demonstrates rapid adaptation in preterm neonates.

Purpose of the Study:

  • To investigate the HPA axis function in preterm infants.
  • To explore the implications of cortisol response in prematurity.
  • To understand HPA axis regulation under various stress conditions.

Main Methods:

  • Observational studies on HPA axis function in preterm infants.
  • Assessment of adrenocortical response to stress.
  • Monitoring of cortisol levels in relation to clinical outcomes.

Main Results:

  • Preterm infants show suboptimal HPA axis response initially, but adapt by day 14.
  • An attenuated cortisol response may offer protection against intracranial bleeding.
  • Severe hypoxic-ischemic encephalopathy strongly stimulates the HPA axis.

Conclusions:

  • The HPA axis in preterm infants is dynamic and adapts rapidly.
  • Cortisol response patterns in prematurity have potential clinical significance.
  • Chronic intrauterine hypoxemia can lead to sustained HPA axis activation and elevated cortisol.

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