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Title: Salivary cortisol as a measure of pain and distress in sick and preterm infants
Author: Kidd, Susan
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2004
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Objective: To evaluate the use of salivary cortisol as a potential tool for assessing sustained distress or pain in sick and preterm infants. Design: 1. Four different saliva collection methods were evaluated for their ease of application in the population and effect on cortisol radioimmunoassay. 2. 50 matched saliva-plasma samples were taken in order to explore the relationship between salivary and total plasma cortisol and estimate the range of values in the study population. 3. A longitudinal study of weekly morning and evening salivary cortisol was undertaken in 11 infants to evaluate the nature of potential circadian rhythm in cortisol secretion. 4. Saliva samples were taken from control infants and infants in 3 ‘presumed distress’ groups: a) Controls (n=40) b) Infants requiring continuous positive airways pressure (CPAP)(n=10) c) Infants requiring conventional mechanical ventilation (n=10) d) Infants with meningitis or necrotising enterocolitis (n=10) Conclusions: 1. Salivary cortisol may be used as a practical tool to assess adrenocrotical activity in sick and preterm infants. Direct suction of ‘straight’ saliva from an infant’s mouth, without citric acid, was the most suitable collection method. The effect of cotton and polyester swabs was presumed to be due to cross-reactivity of swab constituents with the assay antibody. 2. Salivary levels correlated well with total plasma cortisol levels and were higher than previously reported for any population. 3. Classical circadian rhythm in cortisol secretion is not apparent in very preterm infants prior to discharge from hospital. 4. Infants with presumably distressing conditions and treatments had significantly higher salivary cortisol than controls, and illness-severity was not strongly associated with salivary cortisol levels as the degree of presumed distress. Salivary cortisol levels in ‘well’ infants do not vary significantly over the first weeks of life, are not significantly different in preterm and term infants at the age of 3 postnatal days, and are not affected by previous illness.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available