CORTISOL - Skin-to-Skin Contact



CORTISOL 3-28-2014

Salivary – INFANT

Anderson & Chiu, 2002 PT,no significant difference in salivary cortisol before and after heelsticks. A general decrease in cortisol in response

Castral et al. 2012 PT, maternal depression/anxiety did not influence infant salivary cortisol during heel stick or after, but maternal salivary cortisol did influence infant salivary cortisol after heel stick and infant’s HR response to pain.

Cignacco et al.,2009 PT, RCT, cortisol decreases over 3 days and over NICU stay naturally but no

significant difference in cortisol levels before and after heel sticks

Cong et al. 2009 PT, randomized cross over of 80 min and 30 min of KC before KC heelstick or

incubator heel stick. Thirty min study only reduced salivary cortisol after

heelstick and serum salivary cortisol was lower during KC heel stick than

incubator heelstick during the heel stick phase.

D’Apolito 2006 Review, says cortisol is lower in infants in KC during painful procedures.

Dombrowski/Anderson’01

Engler, 2012 PT, salivary cortisol of infants when being held in KC drops as compared to

incubator periods or that there is no difference in salivary cortisol levels.

Feldman, 2009 PT. the drop in cortisol and decreased autonomic reactivity seen in response to

KC when infants was sustained at 10 years of age. CORTISOL EFFECTS

SUSTAINED FOR TEN YEARS!!!!

Feldman et al.,2010 Maternal and infant cortisols were interrelated (same as Neu 2009). Maternal

touch that is myssyncrhonous (when infant is turned away from mother) is

correlated with reduction in cortisol and stressed autonomic system

Feldman et al. 2013 PT, quasi-exp of 73 infants who did or did not get one hour KC/day for 14

consecutive days who were tested at 10 years. KC infants had attenuated stress

response at 10 years as measured by a mean of three cortisol values used in the

multifactorial analysis

Handlin et al. 2009

Hardy, 2011 PT, review of L-H’s Developmental Care text chapter and relates to readers that

cortisol drops within 20 minutes of onset of KC

Henderson 2011 FT. Review of what happens during Birth KC breast crawl and it says that

oxytocin acts directly against cortisol

Gitau et al., 2002 PT, RCT, one session of KC reduced salivary cortisol significantly.

McDermott, 2003 FT, review, separated fullterm infants have pathologic levels of salivary cortisol

Miles et al., 2006 PT, RCT, salivary and serum cortisol taken once per week during weeks of KC

(weeks 1-4) were not significantly different between KC and standard care

groups, and change in salivary cortisol from before to 20 minutes after

immunization at 4 and 12 months age did not differ between groups either. No

significant correlations between variation in amount of KC and cortisol.

Morelius et al., 2005 PT (descrip), cortisol increased in some and decreased in some during KC over 4 days of KC

Modi & Glover,1998 PT. Review of studies. 20 minutes of KC before heelstick caused salivary cortisol to drop in study of KC and massage, but no drop in salivary cortisol after occurred on incubator-only day. Drop in salivary cortisol not sustained one day later, so no residual effect of KC on cortisol levels. Must give given over a prolonged period to produce benefit.

Neu et al., 2009 PT, cortisol co-regulation (a decrease in difference between maternal and infant cortisol values) occurs in mother and infants during KC.

Neu et al., 2010

Neu et al., 2014 PT, RCT, of salivary cortisol over one hour (at 30 mins and 60 mins) of KC holding vs blanket holding to see if maternal and infant cortisols co-regulated. No co-regulation seen after 1 hour per day for 8 weeks before testing.

Nolan & Lawrence, 2009 FT, RCT of 25 infants who got three types of KC (ventral to ventral,

ventral to lateral, cradle hold on mother’s side under axilla) that started

> 30 mins post birth compared in PACU to 25 controls who were not in PACU KC infants had better HR, RR, and temp stabilization and lower

cortisol levels than controls. KC moms had less anxiety and more

satisfaction with their care.

Takahashi, et al.,2010 FT, infants in two groups (initiation 60 minutes). Starting earlier produces better HR stabilization and continuing longer than 60 mins produces lower salivary cortisol levels.

Thukral et al. 2012 FT, RCT of 2 hours of Birth KC. Must get article to learn salivary cortisol result as measured at 48 hrs and 6 mos of life.

Serum- INFANT

Anderson posters

Cong et al., 2009 PT, randomized cross over of 80 min and 30 min of KC before KCheelstick or

incubator heel stick. Only 30 min of KC reduced serum cortisol during the KC

heelstick but not during the incubator heel stick.

Miles et al., 2006 PT, RCT gives ranges for weeks 1-4 for KC and routine care groups and for

changes occurring before and 20 minutes after an immunization at 4 months of

age

Mooncey et al., 1997 PT, 20 min KC caused 66% drop in serum cortisol, wide variation

In basal cortisol levels (47-856 nmol/l inKC; 95-1560 in incubator)

Cortisol also dropped on incubator day, but this was paradoxical

Response to blood draw on that day.

Modi & Glover, 1998 PT, 20 min of KC prior to heelstick caused plasma cortisol to drop 66%

(p=0.008), but nodrop in Cortisol on incubator-only day. Drop in serum cortisol

not sustained one day later.

Tornhage et al. 1998 PT, Pts in KC have lower levels of cortisol and cholescystokinin than babies kept in incubators. NG feeding in KC increased cholecystokinin response to feeding, promoting GI growth and secretion.

SALIVARY CORTISOL -MATERNAL

Bigelow et al., 2012 FT, measured mat anxiety as physiological stress by salivary

cortisol. Comparative effectiveness study shows that 5hrs/ of

KC/day in first week and then >2 hrs/ per day until one month age

reduced salivary cortisol more in KC than in controls who gave

little or no KC. mean value for one week visit was .340 ug/dl (SD=0.163 for

SSC and .278 (SD=.128 ug/dl) for controls; at one month means values dor KC

was 0.234 (sd=0.095) and for controls was 0.244 (SD=0.161) ug/dl but these

were not significantly different. Change from one wk to one month was sign

diff:KC moms had a larger decrease in salivary cortisol over the first month than

controls.

Engler et al., no date yet PT, maternal and infant salivary cortisol levels

Handlin et al, 2009? FT. Breastfeeding reduced mat cortisol and ACTH, increased duration of KC

before suckling on PP day 2 was associated with lower cortisol (but no

association with ACTH).

Miles et al., 2006 PT, RCT, reports taking maternal cortisol but gives no results for this variable.

Morelius et al., 2005 PT (descript) salivary cortisol at 1st KC went down and was lower at 2nd-4th KC sessions and recovered faster at 4th KC session than 1st in mothers.

Neu et al. 2009 PT, mother and baby get salivary cortisol within close synchrony within minutes of KC onset.

Neu et al.. 2014 PT, RCT. took maternal salivary cortisol at 30 and 60 mins of KC and blanket holding after 1 hr/dayX8 weeks to see if co-regulation occurred. It did not.

Swinth et al., 2003 PT, Case study. Maternal salivary cortisol was 0.02-0.13µg/dl over the five days of ventilated KC. Two hours after infant was intubated, mat. cortisol was 0.37

DERMAL CORTISOL

Narendran, Visscher

RELATED MATERIALS

Francis et al., 1987 Infant salivary and Serum cortisols correlate well. (Francis SJ, Walker RF, Riad-Fahmy D, Hughes D, Murphy IF, Gray OP. 1987. Assessment of adrenocortical activity in term newborn infants using salivary cortisol determinations. J Pediatr 111, 129-133.

New procedures for salivary cortisol collection in infants: Morelius E, Nelson N, Theodorsson E. Salivary cortisol and administration of concentrated oral glucose in newborn infants: improved detection limit and smaller sample volumes without glucose interference. Scand J. Clin Lab Invest 2004, 64, 113-118. This procedure makes it possible to collect sufficient amounts of saliva without disturbing the infant during sensitive situations such as maternal infant interaction.

Infants, in contrast to adults, do not have diurnal rhythm of cortisol (Antonini SRR, Jorge SM, Moreira AC. 2000. The emergence of salivary cortisol circadian rhythm and its relationship to sleep activity in preterm infants. Clin Endocrin 52, 423-426; Huysman MWA, Hokken-Koelega ACS, DeRidder MAJ, Sauer PJJ, 2000. Adrenal function in sick very preterm infants. Pediatr Res 48, 629-633.

Metzger dL, Wright NM, Veldhuis JD, Rogol AD Kerrigan JR. 1993. Characterization of pulsatile secretion and clearance of plasma cortisol in premature and term neonates using deconvolution analysis. J Clin Endocrinol Metab. 77(2): 458-463. Study of 5 preterm infants and 5 full term infants. 58 nmol/l=2.1 micrograms/dl). In a six hour period 24-34 ga infants had 4-5 bursts of Circulating plasma concentration of cortisol was 350 ±129 [premature infant) and 277 ±54 nmol/l term infants and pulsatile concentration was 760 ±480 nmol/l (prematures) and 310±100 nmol/l in term infant. Half life of serum cortisol in preterms was 45±6 mins and in term infants was 56±4 mins. Preterm infants have less secretion rate than term infants ( slower to be secreted) but the two most preterm infants had sig. more pulsatile secretion of cortisol than older preterm and term infants.

Search pulsatile cortisol and infants. And you get that cortisol is secreted in a pulsatile fashion that displays a circadian rhythm. With highest levels in early morning and lowest at midnight.

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