title: Hair cortisol as a potential biologic marker of chronic stress in hospitalized neonates.
abstract: BACKGROUND
  As preterm and term infants in the neonatal intensive care unit (NICU) undergo multiple stressful/painful procedures, research is required that addresses chronic stress.
  
  
  OBJECTIVE
  To determine whether (a) hair cortisol levels differed between term and preterm infants exposed to stress in the NICU and (b) an association exists between hair cortisol levels and severity of illness or indicators of acute stress.
  
  
  METHODS
  Hair cortisol levels were determined using the ELISA method (solid-phase enzyme-linked immunoassay, Alpco Diagnostics, Windham, N.H., USA) in 60 infants >25 weeks gestational age at birth.
  
  
  RESULTS
  No significant differences were found between the hair cortisol levels of term infants compared to preterm infants in the NICU. When compared to a group of healthy term infants, hospitalized infants had significantly higher hair cortisol levels (t (76) = 2.755, p = 0.004). A subgroup analysis of the term NICU infants showed a statistically significant association between total number of ventilator days and hair cortisol levels. For every extra day on the ventilator, hair cortisol levels increased on average by 0.2 nmol/g (p = 0.03). 21% of the variance in hair cortisol levels was explained by the total number of days on the ventilator.
  
  
  CONCLUSIONS
  Hair cortisol is influenced by days of ventilation in NICU term infants. This is a potentially valid outcome for chronic neonatal stress in these infants and warrants further investigation.
authors.affiliation: Faculties of Nursing and Medicine, University of Toronto, Toronto, Ont., Canada. janet.yamada@sickkids.ca
authors.forename: Janet
authors.initials: J
authors.lastname: Yamada
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Nicole
authors.initials: N
authors.lastname: de Silva
authors.forename: Sharyn
authors.initials: S
authors.lastname: Gibbins
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Christine
authors.initials: C
authors.lastname: Newman
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006197:Hair / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007231:Infant, Newborn / Q000378:metabolism*; D007234:Infant, Premature / Q000378:metabolism*; D007363:Intensive Care Units, Neonatal; D008297:Male; D010146:Pain / Q000378:metabolism; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone