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.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-016-0933-3) contains supplementary material, which is available to authorized users.

Post-traumatic stress after PICU and corticosteroid use

“…There are indications that high evening cortisol levels are associated with PTSD symptoms in children following PICU admission 1. It is possible that use of exogenous corticosteroids may result in reduced PTSD symptom burden through a mechanism that also involves normalisation of the cortisol-mediated stress response in these children.…”

“…Follow-up assessments for PTSD symptoms and salivary cortisol were performed at 3–6 months post discharge. Primary results of this study have been reported elsewhere 1. For this secondary retrospective exploratory analysis, children under 8 years of age were excluded to conform to the validity of the PTSD scoring tool.…”

“…Symptoms of post-traumatic stress disorder (PTSD) have been detected in approximately 30% of children following discharge from paediatric intensive care units (PICU) 1. Sepsis has been shown to be a relative risk factor 1.…”

“…Sepsis has been shown to be a relative risk factor 1. Aetiological mechanisms are multifold and consideration is being paid towards understanding which children are most at risk in order to develop potential preventative measures.…”

“…Aetiological mechanisms are multifold and consideration is being paid towards understanding which children are most at risk in order to develop potential preventative measures. PTSD symptoms have been associated with high evening salivary cortisol levels after discharge, implying dysregulation of the immunological stress response as a possible contributing factor 1. Genetic mechanisms including the presence of glucocorticoid receptor and corticotrophin-releasing hormone binding protein single nucleotide polymorphismss may influence this outcome 2…”