Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review
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Evalotte Mörelius1, Hong-Gu He2, Shefaly Shorey3
1Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping 60174, Sweden. evalotte.morelius@liu.se.
Insights
Salivary cortisol levels in preterm infants change with interventions. Painful procedures increase cortisol, while music, prone positioning, and co-bedding decrease it, offering insights into stress management in the NICU.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Stress Physiology
Background:
- Salivary cortisol reactivity is increasingly used to assess stress in preterm infants within the Neonatal Intensive Care Unit (NICU).
- Understanding interventions that modulate cortisol levels is crucial for improving infant well-being.
Purpose of the Study:
- To conduct an integrative literature review summarizing evidence on interventions affecting salivary cortisol levels in preterm infants in the NICU.
- To identify specific interventions that either increase or decrease salivary cortisol from baseline.
Main Methods:
- A systematic search of electronic databases (PubMed, CINAHL, Web of Science, Scopus) was performed.
- Inclusion criteria focused on studies involving preterm infants, interventions, salivary cortisol reactivity assessment, and NICU discharge.
- 16 relevant studies published in English were included in the review.
Main Results:
- Eye-screening examinations and heel lances were found to provoke an increase in salivary cortisol levels.
- Interventions such as music, prone positioning, and co-bedding among twins demonstrated a decrease in salivary cortisol levels.
- Several studies noted challenges with successful saliva sampling and a lack of control groups.
Conclusions:
- Specific interventions can modulate salivary cortisol levels in preterm infants, indicating potential avenues for stress reduction.
- Future research should prioritize non-painful interventions and employ robust study designs, including control groups and sensitive cortisol detection methods.
- Standardized methodologies are needed to better understand salivary cortisol regulation and its implications for preterm infant care.
Abstract:
Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.
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