title: Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study.
abstract: 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.
authors.affiliation: Department of Medicine, Centre for Mental Health, Imperial College London, Hammersmith Hospital Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Als
authors.affiliation: Coslada Mental Health Service, Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Picouto
authors.affiliation: Douglas Hospital Research Centre, Montreal, Canada.
authors.forename: Kieran J
authors.initials: KJ
authors.lastname: O'Donnell
authors.affiliation: Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.affiliation: Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Mehrengise
authors.initials: M
authors.lastname: Cooper
authors.affiliation: Department of Paediatric Intensive Care, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Pierce
authors.affiliation: Department of Medicine, Centre for Mental Health, Imperial College London, Hammersmith Hospital Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
authors.forename: Tami
authors.initials: T
authors.lastname: Kramer
authors.affiliation: Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
authors.forename: Vivette A S
authors.initials: VAS
authors.lastname: Glover
authors.affiliation: Department of Medicine, Centre for Mental Health, Imperial College London, Hammersmith Hospital Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK. e.garralda@imperial.ac.uk.
authors.forename: M Elena
authors.identifier: http://orcid.org/0000-0002-0553-4453
authors.initials: ME
authors.lastname: Garralda
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm / Q000502:physiology; D016638:Critical Illness / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D015278:Intensive Care Units, Pediatric; D008131:London; D008297:Male; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000737:chemistry / Q000378:metabolism*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology; D013997:Time Factors
chemical_list: D006854:Hydrocortisone
keywords: Critical illness; Post-traumatic stress disorder; Psychological sequelae; Salivary cortisol