EndocrineSep 15, 2012

Daily patterns of stress hormone levels in infants with heart defects

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 8, 2026

Abstract

Morning salivary cortisol levels were 7.0 nmol/L for infants with acyanotic congenital heart disease and 9.7 nmol/L for those with cyanotic congenital heart disease.

Both groups of infants exhibited similar morning and evening salivary cortisol levels, indicating no significant difference in HPA axis function between acyanotic and cyanotic conditions.
Morning cortisol levels were measured between 0600-0900 h, while evening levels were measured between 2100-2400 h.
The results suggest that chronic hypoxia from cyanotic congenital heart disease does not disrupt the normal circadian rhythm of cortisol secretion.
Both cyanotic and acyanotic infants demonstrated an intact diurnal rhythm by 12 weeks of age.

Simplified

Children with congenital heart disease (CHD) have associated extracardiac co-morbidities at the time of surgery and during ongoing growth and development. Perioperative events include disrupted glucose homeostasis, capillary leak, and fluid retention. The hypothalamic-pituitary-adrenal (HPA) axis has an important role in homeostasis in that the secretion of cortisol contributes to the response to stress, glucose regulation, blood volume control, and immune regulation. We investigated the diurnal rhythm of the HPA axis in infants with CHD by measuring salivary cortisol in the morning (0600-0900 h-circadian peak) and evening (2100-2400 h-circadian nadir). Twenty-nine infants aged 12 weeks to 1 year were included: 16 with acyanotic disease (SpO₂ ≥ 90 %) and 13 with cyanotic disease (SpO2 < 90 %). Morning salivary cortisol was similar between the two groups [acyanotic 7.0 nmol/L (1.8-23.1); cyanotic 9.7 nmol/L (0.9-15.6); p = 0.68]. Evening salivary cortisol was similar between the two groups [acyanotic 0.9 nmol/L (0.2-8.5); cyanotic 1.4 nmol/L (0.5-14.9); p = 0.32]. Both cyanotic and acyanotic groups demonstrated an intact diurnal rhythm. In conclusion, chronic hypoxia secondary to cyanotic CHD does not affect the circadian rhythm of the HPA axis. By 12 weeks of age, infants with hypoxia secondary to cyanotic CHD have a normal cortisol diurnal rhythm.

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Daily patterns of stress hormone levels in infants with heart defects

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