Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

European Child & Adolescent Psychiatry - Tập 26 - Trang 511-519 - 2016
Lorraine C. Als1, Maria D. Picouto2, Kieran J. O’Donnell3, Simon Nadel4, Mehrengise Cooper4, Christine M. Pierce5, Tami Kramer1, Vivette A. S. Glover6, M. Elena Garralda1
1Department of Medicine, Centre for Mental Health, Imperial College London, London, UK
2Coslada Mental Health Service, Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
3Douglas Hospital Research Centre, Montreal, Canada
4Department of Paediatric Intensive Care, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
5Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children NHS Trust, London, UK
6Institute of Reproductive and Developmental Biology, Imperial College London, London, UK

Tóm tắt

In this exploratory case–control study, we investigated basal cortisol regulation in 5–16-year-old children, 3–6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30 min, and waking +12 h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p > 0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12 h) cortisol concentrations (p = 0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3–6 month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.

Tài liệu tham khảo

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