Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm

Pediatr Res. 2019 Sep;86(3):339-347. doi: 10.1038/s41390-018-0243-1. Epub 2018 Dec 12.


Background: Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children.

Methods: Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening).

Results: For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01).

Conclusion: Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenal Glands / physiopathology*
  • Androgens / analysis
  • Anthropometry
  • Birth Weight
  • Blood Pressure*
  • Child
  • Dehydroepiandrosterone / analysis
  • Female
  • Humans
  • Hydrocortisone / analysis*
  • Hypothalamo-Hypophyseal System
  • Infant, Extremely Premature
  • Infant, Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature, Diseases
  • Male
  • Pituitary-Adrenal System
  • Risk
  • Saliva / chemistry
  • Sample Size
  • Stress, Physiological


  • Androgens
  • Dehydroepiandrosterone
  • Hydrocortisone

Grant support