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Salivary cortisol is not associated with dexamethasone response in preterm infants with evolving bronchopulmonary dysplasia

Journal of Perinatology (2024)Cite this article

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Abstract

Objective

Short-term treatment efficacy of systemic dexamethasone (DEX) in preterm infants with bronchopulmonary dysplasia (BPD) is highly variable. Our objective was to assess if salivary cortisol may serve as a reliable biomarker of steroid response.

Study design

Multi-site prospective observational cohort study. Salivary cortisol was measured before and after DEX treatment. Respiratory Severity Score (RSS) quantified clinical response.

Results

Fifty-four infants with median (inter-quartile range) gestational age of 25.1 (24.1,26.5) weeks initiated DEX at 30 (23,48) days’ postnatal age. Median baseline and post-treatment cortisol levels were 0.3 (0.2,0.6) μg/dl; 8.3 (5.5,16.5) nmol/L and 0.2 (0.1,0.3) μg/dl; 5.5 (2.8,8.3) nmol/L, respectively. RSS values decreased by a median of 3.1(1.6,5.0) Change in RSS did not correlate with baseline cortisol or change in cortisol levels.

Conclusion

In this first study to assess salivary cortisol as a biomarker for DEX response in BPD, salivary cortisol did not predict dexamethasone response.

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Fig. 1: Absolute Change in Respiratory Severity score from pre-treatment to day 7 of treatment.
Fig. 2: Correlations between respiratory response to dexamethasone and salivary cortisol.

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Data availability

Data reported in this manuscript can be requested through contacting the corresponding author. De-identified or aggregate portions of the data may be shared within the bounds of the original informed consent process.

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Funding

T Lewis, W Truog: NICHD R21 (1R21HD101111), The Sellers Chair in Pharmacology and Pharmacogenetics, SickKids Foundation

Author information

Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada

    Tamorah Lewis

  2. Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada

    Tamorah Lewis

  3. Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA

    Erik A. Jensen

  4. Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Fayetteville, NC, USA

    Sherry Courtney

  5. Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children’s Hospital, Columbus, OH, USA

    Jonathan Slaughter & Matthew J. Kielt

  6. Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Narayan Prahbu Iyer

  7. Center for Infant Pulmonary Disorders, Children’s Mercy Hospital; and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Cheri Gauldin, Christopher Nitkin & William Truog

  8. Division of Health Services and Outcomes Research, Children’s Mercy Hospital; and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Hung-Wen Yeh

Authors
  1. Tamorah Lewis
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Contributions

TL and WT conceptualized and designed the study, designed the data collection instruments, analyzed the data, drafted the initial manuscript and reviewed the final manuscript. EJ, SC, JS, MK, NPI, CN contributed to study design, recruited patients for the study, supervised colletion of samples and data, and critically reviewed and contributed to revisions of the manuscript. CG was the primary research coordinator for the study, designed data collection tools, collected data and aided in data analysis. HY analyzed the data and contributed to initial manuscript drafting and final manuscript revisions.

Corresponding author

Correspondence to Tamorah Lewis.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Children’s Mercy Hospital IRB approved the study at the primary site in Kansas City, Missouri (REB #1000080681). Each site had local IRB approval prior to patient enrollment and data collection. All methods were performed in accordance with the relevant regulations and IRB approved protocol. Informed consent was obtained from all parents of infants in the study.

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Lewis, T., Jensen, E.A., Courtney, S. et al. Salivary cortisol is not associated with dexamethasone response in preterm infants with evolving bronchopulmonary dysplasia. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02177-x

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