Circadian rhythm of salivary cortisol in infants with congenital heart disease

Caprirolo, Giovanna; Ghanayem, Nancy S.; Murkowski, Kathy; Nugent, Melodee; Simpson, Pippa; Raff, Hershel

doi:10.1007/s12020-012-9791-z

Cited by 6 publications

(3 citation statements)

References 31 publications

(30 reference statements)

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“…The CHD group showed higher cortisol levels, suggesting an increased stress response in infants requiring heart surgery. However, we did not observe significant differences in cortisol levels among the different disease groups, in line with a previous report showing similar salivary cortisol levels in acyanotic and cyanotic children with CHD [ 89 ]. These findings suggest that the loss of DP thymocytes in pediatric patients with complex CHD is not exclusively driven by stress-induced mechanisms.…”

Section: Discussionsupporting

confidence: 92%

Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease

Bremer,

Boxnick,

Glau

et al. 2024

J Clin Immunol

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Congenital heart disease (CHD) is the most common birth defect, and up to 50% of infants with CHD require cardiovascular surgery early in life. Current clinical practice often involves thymus resection during cardiac surgery, detrimentally affecting T-cell immunity. However, epidemiological data indicate that CHD patients face an elevated risk for infections and immune-mediated diseases, independent of thymectomy. Hence, we examined whether the cardiac defect impacts thymus function in individuals with CHD. We investigated thymocyte development in 58 infants categorized by CHD complexity. To assess the relationship between CHD complexity and thymic function, we analyzed T-cell development, thymic output, and biomarkers linked to cardiac defects, stress, or inflammation. Patients with highly complex CHD exhibit thymic atrophy, resulting in low frequencies of recent thymic emigrants in peripheral blood, even prior to thymectomy. Elevated plasma cortisol levels were detected in all CHD patients, while high NT-proBNP and IL-6 levels were associated with thymic atrophy. Our findings reveal an association between complex CHD and thymic atrophy, resulting in reduced thymic output. Consequently, thymus preservation during cardiovascular surgery could significantly enhance immune function and the long-term health of CHD patients.

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Section: Discussionsupporting

confidence: 92%

Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease

Bremer,

Boxnick,

Glau

et al. 2024

J Clin Immunol

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“…Interestingly, children with VSDs showed marginally lower hair cortisol values compared to the control group. Cortisol levels in the normal range for children with VSDs have also been observed in other studies [ 51 , 94 ] and indicate development comparable to non-affected peers. Golub, et al [ 95 ] demonstrated that children with a chronic disease display hypocortisolism.…”

Section: Discussionsupporting

confidence: 82%

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Lang

Gerlach

Plank

et al. 2022

JCM

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Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6–9 years) to adolescence (10–14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times—when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients’ quality of life was increased and internalizing problems were decreased—proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

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“…However, the SpO 2 was significantly lower in non-syndromic conotruncal heart defects compared to patients with 22q11.2 del. This suggests that stress alone cannot explain the low TRECs in 22q11.2 del group, and a study of 29 infants with chronic hypoxia due to cyanotic congenital heart disease, did not show any effect on the HPA axis [29]. However, in the T-cell lymphopenia (TCL) screening, higher rates of abnormal screen are seen in the premature and critical ill infants [30].…”

Section: Trec Values and Heart Surgery/intervention/fatal Outcomementioning

confidence: 97%

T-cell Receptor Excision Circles in Newborns with Heart Defects

et al. 2020

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In the fetus, the cardiac neural crest gives rise to both the thymus and the conotruncus of the heart. In newborn screening for severe T-cell lymphopenia neonates with congenital heart defects may be detected. In this study, we investigated the occurrence of T-cell lymphopenia in neonates with or without 22q11.2 deletion syndrome (del) suffering from heart defects. This retrospective cohort study included 125 patients with heart defects. T-cell receptor excision circles (TRECs), a measure for T-cell lymphopenia, were quantified by RT-PCR using stored newborn screening blood spots. Three patient groups were compared: non-conotruncal defects (n = 57), conotruncal defects (n = 42), and 22q11.2 del with conotruncal defects (n = 26). Significantly lower TREC values were detected in patients with 22q11.2 del and conotruncal heart defects compared to those with non-syndromic conotruncal (p < 0.001) and non-conotruncal (p < 0.001) defects. In contrast, no significant difference was found between patients with non-syndromic conotruncal and non-conotruncal heart defects (p = 0.152). Low TREC levels were obtained in neonates treated with heart surgery/intervention within 2 weeks after birth and in those with a fatal outcome (p = 0.02) independent of patient group. A correlation was found between low TREC numbers and oxygen saturation, SpO 2 below 95% (p = 0.017). The SpO 2 was significantly lower in the non-syndromic conotruncal group compared to non-conotruncal (p < 0.001) and 22q11.2 del group (p = 0.015). No correlation was found between low neonatal TRECs and infections needing hospitalization later in life (p = 0.135). Patients with 22q11.2 del and conotruncal defects have significantly lower TREC levels compared to patients with heart defects without this syndrome. Keywords T-cell receptor excision circles • T-cell lymphopenia • Conotruncus • Conotruncal heart defects • Neural crest • 22q11.2 deletion syndrome Abbreviations ASD Atrial septal defect CGH array Comparative genomic hybridization array Del Deletion syndrome FISH Fluorescent in situ hybridization * Kiran A.

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Circadian rhythm of salivary cortisol in infants with congenital heart disease

Cited by 6 publications

References 31 publications

Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease

Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

T-cell Receptor Excision Circles in Newborns with Heart Defects

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