Arch Dis Child Fetal Neonatal Ed. 2022 Mar 14:fetalneonatal-2021-323296. doi: 10.1136/archdischild-2021-323296. Epub ahead of print. PMID: 35288450.

Acta PaediatricaVolume 106, Issue 12 p. 2060-2061 Brief Report Salivary cortisol circadian rhythm in infants at psychosocial risk showed more variations than previous studies of healthy full-term infants E Mörelius, Corresponding Author E Mörelius Evalotte.morelius@liu.se Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden Correspondence E Mörelius, Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, 601 74 Norrköping, Sweden. Tel: +46-11-363556 | Fax: +46-13-149403 | Email: Evalotte.morelius@liu.seSearch for more papers by this authorK Ivars, K Ivars Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorPA Gustafsson, PA Gustafsson Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorE Theodorsson, E Theodorsson Department of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorN Nelson, N Nelson Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, SwedenSearch for more papers by this author E Mörelius, Corresponding Author E Mörelius Evalotte.morelius@liu.se Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden Correspondence E Mörelius, Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, 601 74 Norrköping, Sweden. Tel: +46-11-363556 | Fax: +46-13-149403 | Email: Evalotte.morelius@liu.seSearch for more papers by this authorK Ivars, K Ivars Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorPA Gustafsson, PA Gustafsson Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorE Theodorsson, E Theodorsson Department of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenSearch for more papers by this authorN Nelson, N Nelson Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, SwedenSearch for more papers by this author First published: 18 August 2017 https://doi.org/10.1111/apa.14023Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume106, Issue12December 2017Pages 2060-2061 RelatedInformation

OBJECTIVES:The aim of the present study was to investigate the adrenocortical response to diaper change in mother-infant dyads with psychosocial risk factors.MATERIAL AND METHODS:Twenty-two mother-infant pairs with well-defined psychosocial problems were included. The mother-infant pairs were treated for 6 weeks in a daycare programme to improve attachment. Salivary cortisol was measured before and after a diaper change during the first and last weeks of enrollment in the programme. Mothers' sensitivity towards their infants' signals was measured using a scale from 1 (highly insensitive) to 9 (highly sensitive) according to Ainsworth.RESULTS:Median salivary cortisol increased in 15 out of 22 infants after the first diaper change. The increase was most pronounced in the group of infants below 3 months of age (n = 15) where median salivary cortisol increased 170% after the first diaper change (P < 0.05) and decreased 19% after the last diaper change (not significant). Out of these 15 infants, 11 showed an increase in salivary cortisol in response to the first diaper change while four out of 15 did so in response to the last diaper change (P < 0.05). The salivary cortisol response did not change over time in infants aged 3 months or above. A mother's sensitivity to her child increased significantly (P < 0.001) from the first to the last week. In mothers, median salivary cortisol decreased 38% after the first diaper change (P < 0.05) and 57% after the last diaper change (P = 0.001).DISCUSSION:A diaper change is normally not perceived as stressful. The stress response caused by a diaper change may illustrate an insufficiency in the mother-infant relationship before treatment. Professional support improved the mothers' sensitivity and stabilized the stress response to diaper change in the youngest infants.

The aims of the present study were to investigate whether the cotton-tipped applicators (cotton buds) used to collect saliva in infants can be stored un-centrifuged prior to cortisol analysis, and to test whether there is any difference in results between wooden and plastic-shafted sticks. Saliva was collected from 10 healthy adults using 6 cotton buds, i.e. 3 with wooden sticks and 3 with plastic sticks. The samples were then centrifuged at three different time-points: immediately after collection, after 24 h and after 48 h. Using cotton buds with wooden sticks, median salivary cortisol was significantly lower after 24 h (40%) (p < 0.001) and after 48 h (49%) (p < 0.001) of storage than it was of the samples centrifuged immediately. There was no significant difference between the samples centrifuged immediately and those centrifuged after 24 h and 48 h when saliva was collected using the cotton buds with plastic sticks. It is concluded that cotton buds with wooden sticks should not be used in studies of salivary cortisol unless it is possible to centrifuge the saliva immediately. Moreover, it is inadvisable to alternate between cotton buds with wooden and plastic sticks in the same study when collecting saliva for analysis of cortisol.

OBJECTIVES:Mother-infant separation after birth is a well-known source of stress. Parents and preterm infants in neonatal intensive care are separated immediately after birth. Skin-to-skin care is 1 possible method to reduce the separation-dependent stress. The aim of the present study was to investigate how skin-to-skin care influences stress for the mother and the infant in neonatal intensive care.METHODS:Seventeen mother-infant pairs were included at their first and fourth skin-to-skin care. The infants were 25 to 33 weeks' gestational age, with birth weights ranging from 495 to 2590 g. In mothers, salivary cortisol, heart rate, mood scale, and stress measured on a visual analog scale (VAS) were analyzed. In infants, salivary cortisol and heart rate were analyzed, and because pain is one facet of stress, 2 different pain scales were used.RESULTS:In mothers, the skin-to-skin care decreased salivary cortisol (32%), heart rate (7%), and VAS (89%), whereas mood increased (6%). Before the fourth skin-to-skin care, mothers rated less stress on VAS, and salivary cortisol and heart rate improved faster. The infants' cortisol either increased or decreased. Their heart rates and pain scores decreased during skin-to-skin care.CONCLUSIONS:Our results lend additional support to the value of skin-to-skin care in neonatal intensive care. Variable stress responses in preterm infants favor the need for individualized care. The mothers' need for support seem to be more pronounced in the first skin-to-skin session as our results show a higher degree of stress as compared with later skin-to-skin care.

Newborn infants are subject to repetitive painful and stressful events during neonatal intensive care. When the baby attempts to cope with a stressful situation the hypothalamus‐pituitary‐adrenal axis is activated, releasing cortisol. The free cortisol response is optimally measured in saliva and saliva samples can be taken easily and without pain. However, saliva is very scarce in infants and saliva stimulants can interfere with analytical methods. Nowadays, sweet solutions are frequently administered to neonates prior to a disturbing procedure in order to reduce pain. The possible interference of sweet solutions with the measurement of salivary cortisol has not yet been documented. The aims of the present study were to further improve the detection limit of the radioimmunoassay used for cortisol analysis and to determine the degree of interference of high concentrations of glucose with the analytical method. By decreasing incubation temperature and prolonging the incubation time it was possible to improve the detection limit of the radio immunoassay (RIA) to 0.5 nmol/L at the same time as the sample volume was decreased to 10 μL saliva. Saliva was collected from full‐term and preterm babies and was sufficient for analysis in 113 out of 116 (97%) samples. Glucose in the concentrations and amounts commonly used for pain relief did not interfere with the RIA method. In conclusion, it is feasible to collect microlitre volumes of saliva and analyse even very low concentrations of cortisol in newborns. It is also possible to offer the baby oral glucose prior to a painful procedure and still reliably measure salivary cortisol.

Background: Infants in neonatal intensive care are exposed to an extremely stressful environment along with several potentially harmful or intrusive interventions as a part of their medical care. The aim of the present study was to investigate if infants exposed to neonatal intensive care have the same pattern of stress response as fullterm healthy infants.Methods: Infants in neonatal intensive care with gestational age range 23–38 w. (NICU) (n=34) and infants with congenital heart disease 36– 42 w. (CHD) (n=23) were compared to a group of healthy fullterm newborns (controls) (n=30). Salivary cortisol was measured at baseline and after a standardised nappy change. The premature infant pain profile (PIPP) and the neonatal infant pain scale (NIPS) were measured before, during, directly after, three minutes after and 30 minutes after the nappy change. The investigation was performed at two different occasions, on day 2–7 (1st) and on day 10–18 (2nd) respectively.Results: NICU and CHD infants had significantly higher cortisol than controls at 1st baseline. At the 2nd occasion all three groups had significantly lower cortisol compared to 1st occasion. NICU infants had a significant decrease in cortisol after their 2nd nappy change compared to baseline which was not seen at 1st occasion or in CHD infants and controls. All groups had a significant increase in pain scores during both nappy changes. The highest pain scores were found in NICU and CHD infants (p=0.000 and 0.008 respectively). The CHD infants had the shortest duration of response to the nappy change. The NICU infants had a prolonged increase in pain score that sustained until the three minutes measure point at 1st occasion and until the 30 minutes measure point at 2nd occasion.Conclusion: Infants exposed to neonatal intensive care (NICU and CHD infants) have a higher salivary cortisol during their first days of life than healthy fullterm infants. The NICU infants expressed a high and prolonged pain response to the nappy change. CHD infants on the other hand, expressed a high but shortlasting pain response to the nappy change. Our results show that infants exposed to neonatal intensive care have a different pattern of stress response than healthy fullterm infants.

BACKGROUND:The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100% inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery.METHOD:Doppler echocardiography was used for the measurement of stroke volume and cardiac output. Pulse oximetry and aortic blood pressure were monitored continuously.RESULTS:Echocardiography revealed no cardiac malformations or signs of persistent fetal circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. Stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery and discharge 4 weeks later the boy is progressing normally.CONCLUSION:Because oxygen delivery is dependent on both blood flow and arterial oxygen content, measurement of cardiac output as well as left heart oxygen saturation is a useful guide to optimizing oxygen delivery. This case report demonstrates how Doppler echocardiographic monitoring of beat-to-beat changes in stroke volume can be used to detect early negative haemodynamic effects of increased mechanical ventilation settings before cardiac output is affected.

Measuring cortisol in saliva offers important advantages compared to measurement in plasma or serum. However, the sampling procedure and also the detection limit cause problems, especially in paediatric and neonatal care. We describe a simple and efficient sampling procedure, together with a modification of a radioimmunoassay, which enables analysis of low (down to 1 nmol/L) concentrations of salivary cortisol (10 times lower detection limit than in the original procedure). This setting was used in studying salivary cortisol concentrations before and after heelstick on healthy newborn infants. A significant rise (median 81%; p<0.01) in salivary cortisol as response to this invasive stressor was noted.

A healthy primigravida had moderate polyhydramnion (amniotic fluid index (AFI) = 230 mm) at 32 gestational weeks. The fetus had dilated, fluid filled, and frequently contracting small bowels filling the whole abdomen (figs 1 and 2), most likely representing distal small bowel atresia or stenosis. At 33 weeks, increasing polyhydramnion (AFI = 430 mm) led to the aspiration of 1180 ml of clear amniotic fluid not stained with meconium. At 36 weeks, the patient had an uneventful spontaneous delivery of …