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Abstract
Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.
Highlights
The hypothalamic–pituitary–adrenal (HPA) axis regulates cortisol production and the organism's capacity to respond to stressors and maintain homeostasis
This review summarizes the evidence of painful, handling, or pleasant interventions that caused a change in salivary cortisol from baseline in preterm infants in the neonatal intensive care unit (NICU)
Salivary cortisol has been used as a marker of stress in preterm infants in the NICU since 1992
Summary
The hypothalamic–pituitary–adrenal (HPA) axis regulates cortisol production and the organism's capacity to respond to stressors and maintain homeostasis. Full-term healthy infants develop a circadian rhythm of salivary cortisol with increasing morning levels and corresponding decreasing evening levels [7]. Developmental immaturity and/or the effects of critical illness on adrenal function may result in insufficient cortisol production to maintain homeostasis when exposed to a stressor [8,9]. Preterm infants may be able to produce enough cortisol to maintain homeostasis under non-stressful conditions, but insufficient cortisol to respond appropriately when exposed to a stressor. An appropriate cortisol release in the face of a stressor is vital for survival and the lack of such a response increases the risk of morbidity and mortality in preterm infants [1]. On the other hand, longstanding high levels of cortisol may increase the risk of cognitive and behavioral problems, high blood pressure, and development of the metabolic syndrome [10,11,12,13,14]
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