Stress Reactivity in Pre-schoolers with Congenital Heart Disease

Project Details

This study compared cortisol regulation and reactivity in 3-5 year old outpatients with congenital heart disease (CHD) who did and did not have cardiac surgery prior to 6 months of age.

Children with congenital heart disease (CHD) have poorer neurodevelopmental and psychological outcomes. The mechanisms underlying this remain unclear. One mechanism could be that the stressful experience of cardiac surgery early in life influences long-term hypothalamic–pituitary–adrenal (HPA) axis regulation. Dysregulation of the HPA axis has been linked to poorer neurocognitive and psychological outcomes in other study populations.

This case–control study  compared HPA-axis regulation (circadian rhythm)  and reactivity using salivary cortisol. The early surgery group had a flatter dirunal slope secondary to lower mean weekend morning waking cortisol levels than the controls (the children with CHD who did not have surgery in the first 6 months of life). The early surgery group also had an increased stress response to an echocardiogram than the controls.

This is the first study to show that cardiac surgery prior to 6 months of age is associated with a different pattern of HPA-axis regulation at 3-5 years of age.


  • Professor Carolina de Weerth and Dr Roseriet Beijers,  Radboud University Medical Centre, Nijmegen,The Netherlands

Research Publications

McGauran, M., Jordan, B., Beijers, R., Janssen, I., Franich-Ray, C., de Weerth, C., & Cheung, M. (2017).  Long-term alternation of the hypothalamic-pituitary-adrenal axis in children undergoing cardiac surgery in the first 6 months of life. Stress: The International Journal on the Biology of Stress, 20(5), 505-512.

Research Group

Paediatric social work research group

Faculty Research Themes

Child Health

School Research Themes

Child Health in Medicine

Key Contact

For further information about this research, please contact the research group leader.

Department / Centre


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