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

Jean Lowe, Janell F Fuller, Allison G Dempsey, Barbara Do, Carla M Bann, Abhik Das, Kathryn E Gustafson, Betty R Vohr, Susan R Hintz, Kristi L Watterberg, SUPPORT NEURO School-Age Study Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Michael S Caplan, Richard A Polin, Abbot R Laptook, Angelita M Hensman, Elisa Vieira, Emilee Little, Katharine Johnson, Barbara Alksninis, Mary Lenore Keszler, Andrea M Knoll, Theresa M Leach, Elisabeth C McGowan, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Allison Payne, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Julie DiFiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Ronald N Goldberg, C Michael Cotten, Kathryn E Gustafson, Ricki F Goldstein, Patricia Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon F Freedman, Melody B Lohmeyer, William F Malcolm, David K Wallace, David P Carlton, Barbara J Stoll, Ira Adams-Chapman, Susie Buchter, Anthony J Piazza, Sheena Carter, Sobha Fritz, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan LaRossa, Yvonne Loggins, Diane Bottcher, Rosemary D Higgins, Stephanie Wilson Archer, Brenda B Poindexter, Gregory M Sokol, Heidi M Harmon, Lu-Ann Papile, Abbey C Hines, Leslie D Wilson, Dianne E Herron, Lucy Smiley, Douglas A Granger, Kathleen A Kennedy, Jon E Tyson, Andrea F Duncan, Allison G Dempsey, Janice John, Patrick M Jones, M Layne Lillie, Saba Siddiki, Daniel K Sperry, Carol J Blaisdell, Abhik Das, Dennis Wallace, Marie G Gantz, Jeanette O'Donnell Auman, Jane A Hammond, Jamie E Newman, W Kenneth Poole, Krisa P Van Meurs, David K Stevenson, M Bethany Ball, Maria Elena DeAnda, Gabrielle T Goodlin, Ivan D Frantz 3rd, John M Fiascone, Elisabeth C McGowan, Anne Kurfiss, Brenda L MacKinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Waldemar A Carlo, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kristy Domanovich, Sally Whitley, Leigh Ann Smith, Carin R Kiser, Neil N Finer, Donna Garey, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Martha G Fuller, Natacha Akshoomoff, Wade Rich, Kathy Arnell, Renee Bridge, Elysia Poggi Davis, Edward F Bell, Tarah T Colaizy, John A Widness, Jonathan M Klein, Karen J Johnson, Michael J Acarregui, Diane L Eastman, Tammy L V Wilgenbusch, Robin K Ohls, Conra Backstrom Lacy, Rebecca A Thomson, Sandra Brown, Pablo J Sánchez, Roy J Heyne, Charles R Rosenfeld, Walid A Salhab, Luc Brion, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Jackie F Hickman, Lizette E Lee, Melissa H Leps, Linda A Madden, Melissa Swensen Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Catherine Twell Boatman, Diana M Vasil, Bradley A Yoder, Roger G Faix, Shawna Baker, Karen A Osborne, Carrie A Rau, Sarah Winter, Sean D Cunningham, Ariel C Ford, Seetha Shankaran, Athina Pappas, Beena G Sood, Rebecca Bara, Thomas L Slovis, Laura A Goldston, Mary Johnson, Jean Lowe, Janell F Fuller, Allison G Dempsey, Barbara Do, Carla M Bann, Abhik Das, Kathryn E Gustafson, Betty R Vohr, Susan R Hintz, Kristi L Watterberg, SUPPORT NEURO School-Age Study Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Michael S Caplan, Richard A Polin, Abbot R Laptook, Angelita M Hensman, Elisa Vieira, Emilee Little, Katharine Johnson, Barbara Alksninis, Mary Lenore Keszler, Andrea M Knoll, Theresa M Leach, Elisabeth C McGowan, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Allison Payne, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Julie DiFiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Ronald N Goldberg, C Michael Cotten, Kathryn E Gustafson, Ricki F Goldstein, Patricia Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon F Freedman, Melody B Lohmeyer, William F Malcolm, David K Wallace, David P Carlton, Barbara J Stoll, Ira Adams-Chapman, Susie Buchter, Anthony J Piazza, Sheena Carter, Sobha Fritz, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan LaRossa, Yvonne Loggins, Diane Bottcher, Rosemary D Higgins, Stephanie Wilson Archer, Brenda B Poindexter, Gregory M Sokol, Heidi M Harmon, Lu-Ann Papile, Abbey C Hines, Leslie D Wilson, Dianne E Herron, Lucy Smiley, Douglas A Granger, Kathleen A Kennedy, Jon E Tyson, Andrea F Duncan, Allison G Dempsey, Janice John, Patrick M Jones, M Layne Lillie, Saba Siddiki, Daniel K Sperry, Carol J Blaisdell, Abhik Das, Dennis Wallace, Marie G Gantz, Jeanette O'Donnell Auman, Jane A Hammond, Jamie E Newman, W Kenneth Poole, Krisa P Van Meurs, David K Stevenson, M Bethany Ball, Maria Elena DeAnda, Gabrielle T Goodlin, Ivan D Frantz 3rd, John M Fiascone, Elisabeth C McGowan, Anne Kurfiss, Brenda L MacKinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Waldemar A Carlo, Namasivayam Ambalavanan, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kristy Domanovich, Sally Whitley, Leigh Ann Smith, Carin R Kiser, Neil N Finer, Donna Garey, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Martha G Fuller, Natacha Akshoomoff, Wade Rich, Kathy Arnell, Renee Bridge, Elysia Poggi Davis, Edward F Bell, Tarah T Colaizy, John A Widness, Jonathan M Klein, Karen J Johnson, Michael J Acarregui, Diane L Eastman, Tammy L V Wilgenbusch, Robin K Ohls, Conra Backstrom Lacy, Rebecca A Thomson, Sandra Brown, Pablo J Sánchez, Roy J Heyne, Charles R Rosenfeld, Walid A Salhab, Luc Brion, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Jackie F Hickman, Lizette E Lee, Melissa H Leps, Linda A Madden, Melissa Swensen Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Catherine Twell Boatman, Diana M Vasil, Bradley A Yoder, Roger G Faix, Shawna Baker, Karen A Osborne, Carrie A Rau, Sarah Winter, Sean D Cunningham, Ariel C Ford, Seetha Shankaran, Athina Pappas, Beena G Sood, Rebecca Bara, Thomas L Slovis, Laura A Goldston, Mary Johnson

Abstract

Background: Extremely preterm (EPT) birth has been related to dysregulation of stress responses and behavioral/learning problems at school age. Early adverse experiences can blunt HPA axis reactivity. We hypothesized that an attenuated cortisol awakening response would be associated with developmental and behavioral problems at school age in EPT children.

Methods: This secondary analysis of a sub-cohort of the SUPPORT study included children born between 24 and 27 weeks, evaluated at 6-7 years with a neurodevelopmental battery and cortisol measures. Differences were tested between EPT and a term-born group. Relationships of cortisol awakening response to test scores were analyzed.

Results: Cortisol was measured in 110 EPT and 29 term-born 6-7 year olds. Unadjusted WISC-IV and NEPSY-II scores were significantly worse among EPT children only. Conners Parent Rating Scale behavior scores were significantly worse among EPT children. After adjusting for covariates, blunted cortisol awakening responses were found to be associated with poorer scores on memory tests and greater problems with inattention for the EPT group (p < 0.05) only.

Conclusions: Among children born EPT, we identified an association of blunted cortisol awakening response with memory and inattention problems. This may have implications related to stress reactivity and its relationship to learning problems in children born EPT.

Gov id: Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324.

Impact: In children born EPT, stress reactivity may have a relationship to learning problems. Cortisol awakening response should be a component for follow-up in EPT born children. Components of executive function, such as memory and attention, are related to stress reactivity.

© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

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