Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study
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.
European Child Adolescent Psychiatry