The prevalence, stability, and impact of blood contamination in children's saliva on the measurement of three of the most commonly assayed hormones were examined. Participants were 363 children (47% boys; ages 6-13 years) from economically disadvantaged families who donated saliva samples on 2 days in the morning, midday, and late afternoon. Samples (n=2178) were later assayed for cortisol (C), testosterone (T), and dehydroepiandrosterone (DHEA). To index the presence of blood (and its components) in saliva, samples were assayed for transferrin. Transferrin levels averaged 0.37 mg/dl (SD=0.46, range 0.0-5.5, Mode=0), and were: (1) highly associated within individuals across hours and days, (2) positively correlated with age, (3) higher for boys than girls, (4) higher in PM than AM samples, and (5) the highest (>1.0 mg/dl) levels were rarely observed in samples donated from the same individuals. Transferrin levels were associated with salivary DHEA and C, but less so for T. As...

Analytes and biomarkers present in saliva may provide insight into individual differences in environmental chemical exposures, variation in reproductive hormones, therapeutic and illegal substance use, changes in stress-related physiology, and the immunologic footprints of infectious disease. The wealth of information provided by salivary analytes has the potential to enrich biobehavioral nursing research by enabling researchers to measure these individual differences in the clinic as well as in patients’ and participants’ everyday social worlds. In this article, the authors provide a roadmap for researchers new to this area who would like to learn more about integrating salivary biospecimens into the next generation of health research. In addition, the authors highlight best practices and strategies to avoid common pitfalls for researchers already engaged in this field.

This research examined whether variations in salivary measures of the hypothalamic-pituitaryadrenal axis (cortisol) and autonomic nervous system (alpha amylase [sAA]) contribute to individual differences in the association between peer victimization and aggression. Children (N = 132; M age = 9.46 years, SD = .33) completed a measure of peer victimization, teachers rated children's aggression, and children's saliva was collected prior to, and following, participation in a laboratory-based peer-oriented social challenge task. Children rated their level of frustration at the end of the task. Results revealed that victimization interacted with cortisol and sAA measured in anticipation of the task to predict aggression; the victimization × cortisol contribution to aggression was partly mediated by children's self-reported frustration level. Victimization also was associated with heightened frustration in girls with high task-related sAA reactivity. Taskrelated sAA reactivity was associated with heightened aggression, but only for girls. These findings suggest that associations between peer victimization and aggression are moderated by variation in the activity of the major components of the psychobiology of stress; results are discussed in relation to theoretical models of individual differences in biological sensitivity to context.

This study examined the association between prenatal tobacco exposure (PTE) and infant cortisol reactivity at 9 months of infant age. Child sex and maternal parenting behavior were hypothesized moderators. The sample included 217 (148 tobacco-exposed, 69 non-exposed) mother-child dyads. Data used were obtained from pregnancy assessments, mother-infant feeding interactions at 2 months, and salivary cortisol at four time points in response to frustration at 9 months. Results indicated a significant association between PTE and infant cortisol that was moderated by infant sex and maternal intrusiveness. That is, PTE boys had lower cortisol than control boys, but there was no association between PTE and cortisol among girls. There was a significant association between PTE and cortisol among infants of intrusive mothers, but not among infants with non-intrusive mothers. Thus, PTE was associated with cortisol hypo-reactivity such that boys and non-exposed infants experiencing high maternal...

Cortisol output in response to emotion induction procedures was examined at child age 24 months in a prospective longitudinal sample of 1,292 children and families in predominantly low-income and non-urban communities in two regions of high poverty in the US. Multilevel analysis indicated that observed emotional reactivity to a mask presentation but not a toy removal procedure interacted with sensitive parenting to predict cortisol levels in children. For children experiencing high levels of sensitive parenting, cortisol output was high among children exhibiting high emotional reactivity and low among children exhibiting low emotional reactivity. For children experiencing low levels of sensitive parenting, cortisol output was unrelated to emotional reactivity.

This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first 2 postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly lowincome communities in the United States. Multilevel growth curve analyses indicated that an index of cumulative risk was positively associated with maternal cortisol across the postpartum (study visits occurring at approximately 7, 15, and 24 months postpartum) over and above effects for African American ethnicity, time of day of saliva collection, age, parity status, having given birth to another child, contraceptive use, tobacco smoking, body mass index, and breastfeeding. Consistent with a psychobiological theory of mothering, maternal salivary cortisol was negatively associated with maternal sensitivity observed during parent-child interactions across the first 2 postpartum years over and above effects for poverty-related cumulative risk, child negative affect, as well as a large number of covariates associated with cortisol and maternal sensitivity. Child negative affect expressed during parent-child interactions was negatively associated with observed maternal sensitivity at late (24 months) but not early time points of observation (7 months) and cumulative risk was negatively associated with maternal sensitivity across the postpartum and this effect strengthened over time. Results advance our understanding of the dynamic, transactional, and psychobiological influences on parental caregiving behaviors across the first 2 postpartum years.

This study examines the interactive contribution of the hypothalamic‐pituitary‐adrenal (HPA) axis and approach‐avoidance motivation systems to longitudinal changes in depressive symptoms across the adolescent transition. In the summer prior to, or fall of, 4th grade, 132 youth (68 girls; 64 boys; M age = 9.46 years) participated in a social challenge task and reported on their depressive symptoms. In the winter of 6th grade, youth completed a semi‐structured interview of depression and a self‐report measure of approach‐avoidance motivations. Analyses revealed two profiles of risk for adolescent depressive symptoms, with some gender differences: (1) excessive disengagement, reflected in HPA underactivation along with low approach motivation or high avoidance motivation; and (2) excessive engagement, reflected in HPA overactivation along with high approach motivation. This research highlights the importance of a multi‐system perspective on development, suggesting that the implications...

Analytes and biomarkers present in saliva may provide insight into individual differences in environmental chemical exposures, variation in reproductive hormones, therapeutic and illegal substance use, changes in stress-related physiology, and the immunologic footprints of infectious disease. The wealth of information provided by salivary analytes has the potential to enrich biobehavioral nursing research by enabling researchers to measure these individual differences in the clinic as well as in patients' and participants' everyday social worlds. In this paper we provide a roadmap for researchers new to this area who would like to learn more about integrating salivary biospecimens into the next generation of health research. In addition, we highlight best practices and strategies to avoid common pitfalls for researchers already engaged in this field.

This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first two postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly low-income communities in the US. Multilevel growth curve analyses indicated that an index of cumulative risk was positively associated with maternal cortisol across the postpartum (study visits occurring at approximately 7, 15, and 24 months postpartum) over and above effects for African American ethnicity, time of day of saliva collection, age, parity status, having given birth to another child, contraceptive use, tobacco smoking, body mass index, and breastfeeding. Consistent with a psychobiological theory of mothering, maternal salivary cortisol was negatively associated with maternal sensitivity observed during parent-child interactions across the first two postpartum years over and above effects for poverty-related cumulative risk, child negative affect, as well as a large number of covariates associated with cortisol and maternal sensitivity. Child negative affect expressed during parent-child interactions was negatively associated with observed maternal sensitivity at late (24 months) but not early time points of observation (7 months) and cumulative risk was negatively associated with maternal sensitivity across the postpartum and this effect strengthened over time. Results advance our understanding of

This study examined the effects of prenatal cocaine exposure on infant hypothalamic-pituitaryadrenal axis activity and reactivity at 7 months of infant age. Participants were 168 caregiver-infant dyads (87 cocaine exposed, 81 not cocaine exposed; 47% boys). Maternal behavior, caregiving instability, and infant growth and behavior were assessed, and children's saliva was sampled before, during, and after standardized procedures designed to elicit emotional arousal. Results revealed cocaine-exposed infants had a high amplitude trajectory of cortisol reactivity compared to noncocaine-exposed infants. Infant gender and caregiving instability moderated this association. The findings support a dual hazard vulnerability model and have implications for evolutionarydevelopmental theories of individual differences in biological sensitivity to context.

Cortisol output in response to emotion induction procedures was examined at child age 24 months in a prospective longitudinal sample of 1,292 children and families in predominantly low-income and non-urban communities in two regions of high poverty in the US. Multilevel analysis indicated that observed emotional reactivity to a mask presentation but not a toy removal procedure interacted with sensitive parenting to predict cortisol levels in children. For children experiencing high levels of sensitive parenting, cortisol output was high among children exhibiting high emotional reactivity and low among children exhibiting low emotional reactivity. For children experiencing low levels of sensitive parenting, cortisol output was unrelated to emotional reactivity.

The emergence of the interdisciplinary field of salivary bioscience has created opportunity for neonatal researchers to measure multiple components of biological systems noninvasively in oral fluids. The implications are profound and potentially high impact. From a single oral fluid specimen, information can be obtained about a vast array of biological systems (e.g., endocrine, immune, autonomic nervous system) and the genetic polymorphisms related to individual differences in their function. The purpose of this review is to describe the state of the art for investigators interested in integrating these unique measurement tools into the current and next generation of research on gonadal steroid exposure during the prenatal and neonatal developmental periods.

We report a case of a newborn with tetrasomy 18p who presents with both a congenital diaphragmatic hernia and a giant hiatal hernia. While these two hernias have been rarely reported together in the newborn period, this represents the first association with the chromosomal abnormality of tetrasomy 18p.

; for the Preterm Erythropoietin Neuroprotection Trial Consortium IMPORTANCE Extremely preterm infants are among the populations receiving the highest levels of transfusions. Erythropoietin has not been recommended for premature infants because most studies have not demonstrated a decrease in donor exposure. OBJECTIVES To determine whether high-dose erythropoietin given within 24 hours of birth through postmenstrual age of 32 completed weeks will decrease the need for blood transfusions. DESIGN, SETTING, AND PARTICIPANTS The Preterm Erythropoietin Neuroprotection Trial (PENUT) is a randomized, double-masked clinical trial with participants enrolled at 19 sites consisting of 30 neonatal intensive care units across the United States. Participants were born at a gestational age of 24 weeks (0-6 days) to 27 weeks (6-7 days). Exclusion criteria included conditions known to affect neurodevelopmental outcomes. Of 3266 patients screened, 2325 were excluded, and 941 were enrolled and randomized to erythropoietin (n = 477) or placebo (n = 464).

; for the Preterm Erythropoietin Neuroprotection Trial Consortium IMPORTANCE Extremely preterm infants are among the populations receiving the highest levels of transfusions. Erythropoietin has not been recommended for premature infants because most studies have not demonstrated a decrease in donor exposure. OBJECTIVES To determine whether high-dose erythropoietin given within 24 hours of birth through postmenstrual age of 32 completed weeks will decrease the need for blood transfusions. DESIGN, SETTING, AND PARTICIPANTS The Preterm Erythropoietin Neuroprotection Trial (PENUT) is a randomized, double-masked clinical trial with participants enrolled at 19 sites consisting of 30 neonatal intensive care units across the United States. Participants were born at a gestational age of 24 weeks (0-6 days) to 27 weeks (6-7 days). Exclusion criteria included conditions known to affect neurodevelopmental outcomes. Of 3266 patients screened, 2325 were excluded, and 941 were enrolled and randomized to erythropoietin (n = 477) or placebo (n = 464).

Objective:To characterize infants affected with perinatal hypoxic ischemic encephalopathy (HIE) who were referred to regional neonatal intensive care units (NICUs) and their related short-term outcomes.Study Design:This is a descriptive study evaluating the data collected prospectively in the Children's Hospital Neonatal Database, comprised of 27 regional NICUs within their associated children's hospitals. A consecutive sample of 945 referred infants born ⩾36 weeks' gestation with perinatal HIE in the first 3 days of life over approximately 3 years (2010-July 2013) were included. Maternal and infant characteristics are described. Short-term outcomes were evaluated including medical comorbidities, mortality and status of survivors at discharge.Result:High relative frequencies of maternal predisposing conditions, cesarean and operative vaginal deliveries were observed. Low Apgar scores, profound metabolic acidosis, extensive resuscitation in the delivery room, clinical and...

To assess whether late surfactant treatment in extremely low gestational age (GA) newborn infants requiring ventilation at 7-14 days, who often have surfactant deficiency and dysfunction, safely improves survival without bronchopulmonary dysplasia (BPD). Extremely low GA newborn infants (GA ≤28 0/7 weeks) who required mechanical ventilation at 7-14 days were enrolled in a randomized, masked controlled trial at 25 US centers. All infants received inhaled nitric oxide and either surfactant (calfactant/Infasurf) or sham instillation every 1-3 days to a maximum of 5 doses while intubated. The primary outcome was survival at 36 weeks postmenstrual age (PMA) without BPD, as evaluated by physiological oxygen/flow reduction. A total of 511 infants were enrolled between January 2010 and September 2013. There were no differences between the treated and control groups in mean birth weight (701 ± 164 g), GA (25.2 ± 1.2 weeks), percentage born at GA <26 weeks (70.6%), race, sex, severity of l...