The development of the hypothalamus-pituitary-adrenal axis during infancy may be affected by antenatal glucocorticoid
F Niwa1,2, M Kawai1, H Kanazawa3,4
1Department of Pediatrics, Graduate School of Medicine, Kyoto University, Japan.
Insights
Antenatal glucocorticoids (AG) may alter the infant hypothalamus-pituitary-adrenal (HPA) axis development in preterm infants. This can lead to an upregulated HPA axis, potentially causing long-term health issues.
Area of Science:
- Neonatal physiology
- Endocrinology
- Developmental biology
Background:
- Hypothalamus-pituitary-adrenal (HPA) axis development in preterm infants remains unclear.
- Potential long-term health impacts of altered HPA axis development in preterm infants.
- Limited research exists on the effects of antenatal glucocorticoids (AG) on infant HPA axis development.
Purpose of the Study:
- To investigate the impact of antenatal glucocorticoids (AG) on the developing HPA axis in preterm infants.
- To compare HPA axis function in preterm infants exposed versus unexposed to AG therapy.
- To understand potential long-term health consequences associated with these developmental changes.
Main Methods:
- Salivary cortisol levels were measured pre- and post-palivizumab vaccination at three-month intervals during infancy.
- Cortisol secretion response to vaccination was analyzed in infants with and without antenatal glucocorticoid (AG) exposure.
- Statistical comparisons were made between the AG and Non-AG groups.
Main Results:
- The HPA axis response to palivizumab vaccination weakened with age in the Non-AG group.
- The AG group showed an opposite pattern, with the HPA axis response strengthening with age.
- Significant differences in cortisol changes (delta cortisol) were observed between the AG and Non-AG groups.
Conclusions:
- Preterm infants exposed to antenatal glucocorticoids (AG) may exhibit an upregulated HPA axis during infancy.
- This HPA axis upregulation could be linked to potential long-lasting health problems.
- Further research is warranted to confirm these findings and explore clinical implications.
Background:
Developmental changes in the hypothalamus-pituitary-adrenal (HPA) axis during infancy have been reported in term infants, but those in preterm infants have yet to be elucidated. If developmental changes in the HPA axis of preterm infants are modulated by any factors, it may affect their future health. Few studies have examined the lasting consequences of antenatal glucocorticoids on the development of the HPA axis.
Methods:
We measured pre- and post-palivizumab vaccination salivary cortisol values in two conforming periods of three-months intervals during infancy, and compared cortisol values and the response of cortisol secretion between groups with and without antenatal glucocorticoid (AG) therapy.
Results:
Although the strength of the response of cortisol secretion to palivizumab fell age-dependently (until late infancy) in the Non-AG group, the opposite pattern was exhibited in the AG group. The changes of the delta cortisol values between the 2 groups were significant.
Conclusions:
This study suggests that the HPA axis of preterm infants whose mothers receive AG therapy may be upregulated during infancy, possibly leading to long lasting health problems.
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