Cortisol levels as preterms age

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Cortisol is a potent developmental regulator that is normally very low in the fetus until just prior to term. Following preterm birth, the newborn must increase plasma cortisol to support multiple physiologic and metabolic adaptations. Cortisol then remains elevated relative to fetal levels until term equivalence. In animal models, fetal corticosteroid exposures can result in altered neuroendocrine regulation and behavior as the newborn grows to become an adult. Grunau et al report the developmental trajectory of salivary cortisol in large cohorts of 23-28 weeks, 28-32 weeks, and term infants at 3, 6, 8, and 18 months corrected age. The preterms have low cortisol levels at 3 months, but high levels at 8 and 18 months, indicating dysregulation of cortisol homeostasis relative to term infants. The multiple effects of cortisol on developing systems suggest that these altered cortisol levels as preterms age may contribute to collateral changes in physiologic and metabolic responses that may be long lasting.

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