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Cortisol awakening response and developmental outcomes at 6-7 years in children born extremely preterm

Jean Lowe1, Janell F Fuller2, Allison G Dempsey3

  • 1Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

Pediatric Research
|June 17, 2022
PubMed

Insights

Children born extremely preterm (EPT) may have blunted cortisol awakening responses linked to memory and attention issues. This highlights the connection between stress reactivity and learning challenges in EPT individuals.

Area of Science:

  • Neuroscience
  • Developmental Psychology
  • Endocrinology

Background:

  • Extremely preterm (EPT) birth is associated with stress response dysregulation and later behavioral/learning difficulties.
  • Early adverse experiences can attenuate Hypothalamic-Pituitary-Adrenal (HPA) axis reactivity.
  • A blunted cortisol awakening response (CAR) in EPT children may correlate with developmental and behavioral problems.

Purpose of the Study:

  • To investigate the association between cortisol awakening response and neurodevelopmental/behavioral outcomes in school-aged children born extremely preterm.
  • To compare neurodevelopmental and behavioral outcomes, along with CAR, between EPT children and term-born controls.

Main Methods:

  • Secondary analysis of a sub-cohort from the SUPPORT study, including EPT children (born 24-27 weeks gestation) and term-born controls.
  • Neurodevelopmental assessment using WISC-IV and NEPSY-II, behavioral assessment with Conners Parent Rating Scale, and cortisol measurements at 6-7 years of age.
  • Statistical analysis to compare groups and examine relationships between CAR and cognitive/behavioral scores.

Main Results:

  • EPT children (n=110) exhibited significantly poorer unadjusted WISC-IV and NEPSY-II scores and worse behavior scores compared to term-born controls (n=29).
  • Blunted cortisol awakening responses were significantly associated with poorer memory test scores and increased inattention problems specifically in the EPT group (p < 0.05) after adjusting for covariates.
  • No significant associations were found between CAR and cognitive/behavioral outcomes in the term-born control group.

Conclusions:

  • An association exists between a blunted cortisol awakening response and problems with memory and attention in children born extremely preterm.
  • These findings suggest that stress reactivity, as indicated by CAR, may play a role in the learning difficulties observed in EPT children.
  • Cortisol awakening response assessment could be a valuable component in the follow-up care for EPT children, particularly concerning executive functions like memory and attention.
Abstract

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