ArticlePediatric endocrinology, diabetes, and metabolism2023
The influence of repeated pain exposure on morning salivary cortisol in term and preterm neonates.
Article in Pediatric endocrinology, diabetes, and metabolism, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it, 3 citations in OpenAlex.
- Assessment of cortisol as a neonatal pain biomarker in the application of non-pharmacological analgesia therapies: systematic review and meta-analysis.BMC pediatrics · 2025Pooled it
- The effect of breast milk odor on infant pain and stress levels: a systematic review and meta-analysis.BMC pediatrics · 2025Pooled it
- Physiological correlates of pain in preterm infants: evidence from a meta-analytic approach.Frontiers in pediatrics · 2026Review
- Differences in cortisol levels between preterm and term infants: a systematic review and meta-analysis combined with Mendelian randomization study.Frontiers in pediatrics · 2026Review
- Neonatal Pain Management: Is There An Endocrinal Response?Endocrine, metabolic & immune disorders drug targets · 2025Review
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntroduction: Because neonates in the intensive care units (ICU) experience recurrent stress due to painful medical procedures, they are at risk of dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. Aim of the study: To evaluate the influence of repeated pain exposure on morning salivary cortisol (SC) in newborns admitted to the ICU. MATERIAL AND
methodsThe neonates were divided into 3 groups: term (370/7-416/7 weeks), moderate to late preterm (320/7-366/7 weeks), and very preterm (< 320/7 weeks). The hospital stay was prospectively monitored for the number of the most common medical procedures. At least 2 saliva samples for morning SC were collected after completion of 35 weeks of postmenstrual age (PMA) in preterm infants and before discharge in term neonates. The results of SC were compared with the reference intervals for healthy term newborns.
resultsThe study group consisted of 57 patients: 21 term, 17 moderate to late preterm, and 19 very preterm neonates. Very preterm neonates obtained the highest values of mean morning SC in comparison to moderate to late preterm and term infants (3.83 [1.67-8.81] ng/ml vs. 2.44 [1.94-4.38] ng/ml vs. 2.15 [1.5-5.25] ng/ml, p = 0.45). The relationship between mean morning SC and the number of invasive blood samplings was found only in term newborns (Rs = -0.44, p < 0.05). 46% of all SC measurements in very preterm, 47% in moderate to late preterm, and 46% in term infants were within the reference intervals for healthy newborns.
conclusionsHigh exposure to painful procedures seems to dampen the morning SC in term, but not in preterm infants.
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