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Mekanik ventilasyon modlarının prematüre bebeklerin tükürük kortizol düzeylerine etkisi

Year 2023, Volume: 48 Issue: 4, 1339 - 1346, 29.12.2023
https://doi.org/10.17826/cumj.1357170

Abstract

Amaç: Bu çalışmada prematüre bebeklerin tükürük kortizol düzeyini ölçerek mekanik ventilasyon modları ile stres düzeyleri arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Çalışma grubunu solunum desteği alan 65 prematüre bebek, kontrol grubunu ise 43 prematüre bebek oluşturdu. Ağrının değerlendirilmesinde Yenidoğan Bebek Ağrı Ölçeği (NIPS) kullanıldı. Stres düzeyini belirlemek amacıyla doğum sonrası 4. gün sabah ve akşam alınan tükürük örneklerinde tükürük kortizol düzeylerine bakıldı.
Bulgular: Çalışma grubundaki bebeklerin sabah kortizol değerleri 8,33±5,7 ng/ml, akşam kortizol değerleri 8,05±5,6 ng/ml, kontrol grubundaki bebeklerin sabah kortizol değerleri 1,50±0,7 ng/ml, akşam kortizol değerleri 1,48±0,7 ng/ml ölçüldü. Çalışma grubundaki bebeklerin sabah ve akşam tükürük kortizol düzeyleri kontrol grubundaki bebeklere göre anlamlı düzeyde yüksek bulundu. Çalışma grubundaki bebeklerden invaziv mekanik ventilasyon uygulanan bebeklerin sabah kortizol değerleri 12,46±5,3 ng/ml, akşam kortizol değerleri 12,0±5,2 ng/ml, non-invaziv mekanik ventilasyon uygulanan bebeklerin sabah kortizol değerleri 4,57±2,7 ng/ml, akşam kortizol değerleri 4,41±2,7 ng/ml ölçüldü. İnvaziv mekanik ventilasyon uygulanan bebeklerin hem sabah hem de akşam tükürük kortizol düzeyleri, non-invaziv mekanik ventilasyon uygulanan bebeklerin kortizol düzeylerinden yüksekti.
Sonuç: İnvaziv yöntemlerde artan tükürük kortizol düzeyleri, entübasyonun yenidoğanlarda ağrı ve strese neden olduğunu göstermektedir.

Project Number

Cukurova University Scientific Project Department funded this study, Project number TTU-2020-13052.

References

  • Kelly MM. The basics of prematurity. J Pediatr Health Care. 2006;20:238-44.
  • Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010;31:487.
  • Zhao T, Griffith T, Zhang Y, Li H, Hussain N, Lester B et al. Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization. Pediatr Res. 2022;92:1695-1704.
  • Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008;5:e129.
  • Collados-Gómez L, Camacho-Vicente V, González-Villalba M, Sanz-Prades G, Bellón-Vaquerizo B. Neonatal nurses’ perceptions of pain management. Enferm Intensiva. 2018;29:41-7.
  • Maxwell LG, Malavolta CP, Fraga MV. Assessment of pain in the neonate. Clin Perinatol. 2013;40:457-69.
  • McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020;88:168-75.
  • Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, Sadeghi T. Neonate pain management: what do nurses really know? Glob J Health Sci. 2014;6:284.
  • Sheng JA, Bales NJ, Myers SA, Bautista AI, Roueinfar M, Hale TM et al. The hypothalamic-pituitary-adrenal axis: Development, programming actions of hormones, and maternal-fetal interactions, Front Behav Neurosci. 2021;14:601939.
  • Brummelte S, Chau CM, Cepeda IL, Degenhardt A, Weinberg J, Synnes AR, et al. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology. 2015;51:51-63.
  • Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34:163-71.
  • Maas C, Ringwald C, Weber K, Engel C, Poets CF, Binder G et al. Relationship of salivary and plasma cortisol levels in preterm infants: results of a prospective observational study and systematic review of the literature. Neonatology. 2014;105:312-8.
  • Cândia MF, Osaku EF, Leite MA, Toccolini B, Costa NL, Teixeira SN et al. Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: pilot study. Rev Bras Ter Intensiva. 2014;26:69-75.
  • Gunes T, Koklu E, Ozturk MA, Koklu S, Cetin N. Evaluation of serum cortisol levels in a relatively large and mature group of ventilated and nonventilated preterm infants with respiratory distress syndrome. Am J Perinatol. 2006;23:335-9.
  • Calixto C, Martinez FE, Jorge SM, Moreira AC, Martinelli CE. Correlation between plasma and salivary cortisol levels in preterm infants. J Pediatr. 2002;140:116-8.
  • Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12:59-66.
  • Rokicki W, Forest MG, Loras B, Bonnet H, Bertrand J. Free cortisol of human plasma in the first three months of life. Biol Neonate. 1990;57:21-9.
  • Hudson-Barr D, Capper-Michel B, Lambert S, Palermo TM, Morbeto K, Lombardo S. Validation of the pain assessment in neonates (PAIN) scale with the neonatal infant pain scale (NIPS). Neonatal Netw. 2002;21:15-21.
  • Cabral DM, Antonini SRR, Custódio RJ, Martinelli CE, Da Silva CAB. Measurement of salivary cortisol as a marker of stress in newborns in a neonatal intensive care unit. Horm Res Paediatr. 2013;79:373-8.
  • Baid SK, Sinaii N, Wade M, Rubino D, Nieman LK. Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels: a comparison of assays to establish hypercortisolism. J Clin Endocrinol Metab. 2007;92:3102-7.
  • Boyle EM, McIntosh N. Sedation and Analgesia. In Manual of Neonatal Respiratory Care (Ed S Donn): 473-84. New York, Springer, 2012.
  • Cone S, Pickler RH, Grap MJ, McGrath J, Wiley PM. Endotracheal suctioning in preterm infants using four-handed versus routine care. J Obstet Gynecol Neonatal Nurs. 2013;42:92-104.
  • Pillai Riddell RR, Stevens BJ, McKeever P, Gibbins S, Asztalos L, Katz J, Ahola S, et al. Chronic pain in hospitalized infants: health professionals' perspectives. J Pain. 2009;10:1217-25.
  • Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn infants?: A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med. 2003;157:1058-64.
  • Açıkgöz A, Yıldız S. Effects of open and closed suctioning systems on pain in newborns treated with mechanical ventilation. Pain Manag Nurs. 2015;16:653-63.
  • Carbajal R, Eriksson M, Courtois E, Boyle E, Avila-Alvarez A, Andersen RD, et al. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study. Lancet Respir Med. 2015;3:796-812.
  • Mörelius E, Hellström-Westas L, Carlén C, Norman E, Nelson N. Is a nappy change stressful to neonates? Early Hum Dev. 2006;82:669-76.

Effect of mechanical ventilation modes on salivary cortisol levels in preterm infants

Year 2023, Volume: 48 Issue: 4, 1339 - 1346, 29.12.2023
https://doi.org/10.17826/cumj.1357170

Abstract

Purpose: The aim of this study was to examine the relationship between mechanical ventilation modes and stress levels by measuring salivary cortisol levels in preterm infants.
Materials and Methods: The study group comprised 65 preterm infants on respiratory support and 43 control preterm infants. The Neonatal Infant Pain Scale (NIPS) was used to evaluate pain. To determine the stress level, salivary cortisol levels were studied in saliva samples taken in the morning and evening on the 4th postnatal day.
Results: In the study group, morning and evening cortisol levels of the infants were measured 8.33±5.7 ng/ml and 8.05±5.6 ng/ml, respectively. In the control group, morning and evening cortisol values of the infants were measured 1.50±0.7 ng/ml and 1.48±0.7 ng/ml, respectively. The morning and evening salivary cortisol levels of the infants in the study group were significantly higher than those of the infants in the control group. In the invasive mechanical ventilation group infants, morning and evening cortisol levels of the infants were measured 12.46±5,3 ng/ml and 12.0±5,2 ng/ml, respectively. In the non-invasive mechanical ventilation group, morning and evening cortisol values were measured 4.57±2.7 ng/ml and 4.41±2.7 ng/ml, respectively. Both morning and evening salivary cortisol levels of infants on invasive mechanical ventilation were higher than those of infants on non-invasive mechanical ventilation.
Conclusion: Increased salivary cortisol levels in invasive modes indicate that intubation causes pain and stress in newborns.

Supporting Institution

Çukurova Üniversitesi

Project Number

Cukurova University Scientific Project Department funded this study, Project number TTU-2020-13052.

References

  • Kelly MM. The basics of prematurity. J Pediatr Health Care. 2006;20:238-44.
  • Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010;31:487.
  • Zhao T, Griffith T, Zhang Y, Li H, Hussain N, Lester B et al. Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization. Pediatr Res. 2022;92:1695-1704.
  • Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008;5:e129.
  • Collados-Gómez L, Camacho-Vicente V, González-Villalba M, Sanz-Prades G, Bellón-Vaquerizo B. Neonatal nurses’ perceptions of pain management. Enferm Intensiva. 2018;29:41-7.
  • Maxwell LG, Malavolta CP, Fraga MV. Assessment of pain in the neonate. Clin Perinatol. 2013;40:457-69.
  • McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020;88:168-75.
  • Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, Sadeghi T. Neonate pain management: what do nurses really know? Glob J Health Sci. 2014;6:284.
  • Sheng JA, Bales NJ, Myers SA, Bautista AI, Roueinfar M, Hale TM et al. The hypothalamic-pituitary-adrenal axis: Development, programming actions of hormones, and maternal-fetal interactions, Front Behav Neurosci. 2021;14:601939.
  • Brummelte S, Chau CM, Cepeda IL, Degenhardt A, Weinberg J, Synnes AR, et al. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology. 2015;51:51-63.
  • Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34:163-71.
  • Maas C, Ringwald C, Weber K, Engel C, Poets CF, Binder G et al. Relationship of salivary and plasma cortisol levels in preterm infants: results of a prospective observational study and systematic review of the literature. Neonatology. 2014;105:312-8.
  • Cândia MF, Osaku EF, Leite MA, Toccolini B, Costa NL, Teixeira SN et al. Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: pilot study. Rev Bras Ter Intensiva. 2014;26:69-75.
  • Gunes T, Koklu E, Ozturk MA, Koklu S, Cetin N. Evaluation of serum cortisol levels in a relatively large and mature group of ventilated and nonventilated preterm infants with respiratory distress syndrome. Am J Perinatol. 2006;23:335-9.
  • Calixto C, Martinez FE, Jorge SM, Moreira AC, Martinelli CE. Correlation between plasma and salivary cortisol levels in preterm infants. J Pediatr. 2002;140:116-8.
  • Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12:59-66.
  • Rokicki W, Forest MG, Loras B, Bonnet H, Bertrand J. Free cortisol of human plasma in the first three months of life. Biol Neonate. 1990;57:21-9.
  • Hudson-Barr D, Capper-Michel B, Lambert S, Palermo TM, Morbeto K, Lombardo S. Validation of the pain assessment in neonates (PAIN) scale with the neonatal infant pain scale (NIPS). Neonatal Netw. 2002;21:15-21.
  • Cabral DM, Antonini SRR, Custódio RJ, Martinelli CE, Da Silva CAB. Measurement of salivary cortisol as a marker of stress in newborns in a neonatal intensive care unit. Horm Res Paediatr. 2013;79:373-8.
  • Baid SK, Sinaii N, Wade M, Rubino D, Nieman LK. Radioimmunoassay and tandem mass spectrometry measurement of bedtime salivary cortisol levels: a comparison of assays to establish hypercortisolism. J Clin Endocrinol Metab. 2007;92:3102-7.
  • Boyle EM, McIntosh N. Sedation and Analgesia. In Manual of Neonatal Respiratory Care (Ed S Donn): 473-84. New York, Springer, 2012.
  • Cone S, Pickler RH, Grap MJ, McGrath J, Wiley PM. Endotracheal suctioning in preterm infants using four-handed versus routine care. J Obstet Gynecol Neonatal Nurs. 2013;42:92-104.
  • Pillai Riddell RR, Stevens BJ, McKeever P, Gibbins S, Asztalos L, Katz J, Ahola S, et al. Chronic pain in hospitalized infants: health professionals' perspectives. J Pain. 2009;10:1217-25.
  • Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn infants?: A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med. 2003;157:1058-64.
  • Açıkgöz A, Yıldız S. Effects of open and closed suctioning systems on pain in newborns treated with mechanical ventilation. Pain Manag Nurs. 2015;16:653-63.
  • Carbajal R, Eriksson M, Courtois E, Boyle E, Avila-Alvarez A, Andersen RD, et al. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study. Lancet Respir Med. 2015;3:796-812.
  • Mörelius E, Hellström-Westas L, Carlén C, Norman E, Nelson N. Is a nappy change stressful to neonates? Early Hum Dev. 2006;82:669-76.
There are 27 citations in total.

Details

Primary Language English
Subjects Neonatology
Journal Section Research
Authors

Mehmet Satar 0000-0002-5718-0503

Selin Kaplan 0000-0002-1415-7768

Abdullah Tuli 0000-0002-6475-1087

Ümmühan Fulden Aydın 0000-0003-2603-739X

Hacer Yapıcıoğlu 0000-0001-6295-553X

Nejat Narlı 0000-0002-0474-3288

Project Number Cukurova University Scientific Project Department funded this study, Project number TTU-2020-13052.
Publication Date December 29, 2023
Acceptance Date December 11, 2023
Published in Issue Year 2023 Volume: 48 Issue: 4

Cite

MLA Satar, Mehmet et al. “Effect of Mechanical Ventilation Modes on Salivary Cortisol Levels in Preterm Infants”. Cukurova Medical Journal, vol. 48, no. 4, 2023, pp. 1339-46, doi:10.17826/cumj.1357170.