Skip to main content
SpringerLink
Log in

The hormonal and metabolic response to stress in the neonate

  • Main Topic
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Conclusions

It is apparent that adult patients demonstrate a catabolic response to the stresses induced by operative or accidental trauma. It seems that the degree of this catabolic response may be quantitatively related to the extent of the trauma or the magnitude of associated complications such as infection. The host response to infection, traumatic injury, or major operative stress is characterized by such events as fever, pituitary and stress hormone elaboration, mineral redistribution, and increased acute-phase protein synthesis [21].

The beneficial effects of this stress response consist in providing alternate energy sources to meet metabolic demands and essential building blocks for synthetic activities occuring in the postoperative period. It has been suggested that the hyperglycemic response is essential for supplying the increased glucose requirements of injured tissue [81]. In addition, the proteolytic component of the stress response provides the necessary amino acid elements for reparative protein synthesis and production of acute-phase reactants by the liver. The changes in metabolic patterns induced by the stress response are satisfied in part by increased lipolysis and ketogenesis to provide an alternate source of metabolic fuel for tissues such as the brain and skeletal muscle. Additionally, the observed gluconeogenesis may aid in maintaining the glucose supply for vital organs principally dependent on glucose [52, 160].

This metabolic response has also been shown to potentiate many adverse conditions in the postoperative period and to further exacerbate the stress response. Examples include a hypermetabolic state with attendant increased VO2, increased energy requirements, increased temperature, elevated cardiac output, and altered or impaired inflammatory or immune-responsiveness. Numerous investigators have demonstrated that adult patients exposed to severe degrees of traumatic stress are subjected to greatly increased rates of complications such as cardiac or pulmonary insufficiency, myocardial infarction, impaired hepatic and/or renal function, gastric stress ulcers, and sepsis. Furthermore, evidence exists to suggest that this response may be life-threatening if the induced catabolic activity remains excessive or unchecked for a prolonged period. Moyer et al. were able to identify with a great degree of certainty the patients who were likely to die based on a single analysis of a variety of plasma-borne substrates obtained up to 9 days prior to death [103].

It is apparent that modulating or blunting the catabolic response induced by the stress state may have beneficial effects. In studies of postoperative pain management, improved pain control resulted in reduction of postoperative nitrogen loss and shortened periods of convalescence following operation [28, 88].

It is evident from this review that human newborns, even those born prematurely, are capable of mounting an endocrine and metabolic response to operative stress. Unfortunately, many of the areas for which a relatively well-characterized response exists in adults are poorly documented in neonates. As is the case in adults, the response seems to be primarily catabolic in nature because the combined hormonal changes include an increased release of catabolic hormones such as catecholamines, glucagon, and corticosteroids coupled with suppression of and peripheral resistance to the effects of the primary anabolic hormone, insulin.

The catecholamines may be the agents of primary importance in this response, and thus may modulate the remaining components of the hormonal response to stress as well as the metabolic changes, including inhibition of insulin release, marked hyperglycemia, and breakdown of the neonate's stores of nutrients (carbohydrate, protein, and fat). These reactions ultimately result in the release of glucose, NEFA, ketone bodies, and amino acids. Although these metabolic by-products are necessary to meet the body's altered energy needs in a time of increased metabolic demands, it is not difficult to imagine that a severe or prolonged response would be very detrimental to a previously ill neonate with limited reserves of nutrients and already high metabolic demands imposed by rapid growth, organ maturation, and adaptation to the postnatal environment. Preliminary investigations by Anand et al. outlined in this review indicate that alterations in anesthetic technique with the addition of agents such as halothane and fentanyl may be able to significantly blunt this catabolic response. In addition, it appears that modulation of the immune response may also greatly affect the postoperative catabolic response. It is hopeful that future developments and the acquisition of more detailed knowledge o the response will allow us to modify the stress response in neonates in order to further decrease their mortality and morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allison SP, Hinton P, Chamberlain MJ (1968) Intravenous glucose tolerance, insulin and free fatty acid evels in burned patients. Lancet II: 1113

    Google Scholar 

  2. Allison SP, Tomlin PJ, Chamberlain MJ (1969) Some effects of anaesthesia and surgery on carbohydrate and fat metabolism. Br J Anaesthesia 41: 588

    Google Scholar 

  3. Alberti KGMM, Batstone GF, Foster KJ, Johnston DG (1980) Relative role of various hormones mediating the metabolic response to injury. J Parent Ent Nutr 4: 141

    Google Scholar 

  4. Anand KJS (1985) Metabolic and Endocrine Effects of Surgery and Anaesthesia in the Human Newborn Infant. D Phil Thesis, University of Oxford

  5. Anand KJS, Aynsley-Green A (1985) Metabolic and endocrine effects of surgical ligation of patent ductus arteriosus in the human preterm neonate: Are there implications for further improvement of postoperative outcome? Mod Probl Paediatr 23: 143

    Google Scholar 

  6. Anand KJS, Hickey PR (1987) Pain and its effects in the human neonate and fetus. New Engl J Med 317: 1321

    Google Scholar 

  7. Anand KJS, Brown MJ, Bloom SR, Aynsley-Green A (1985) Studies on the hormonal regulation of fuel metabolism in the human newborn infant undergoing anesthesia and surgery. Hormone Res 22: 115

    Google Scholar 

  8. Anand KJS, Brown MJ, causon RC, Christofides ND, Bloom SR, Aynsley-Green A (1985) Can the human neonate mount an endocrine and metabolic response to surgery? J Ped Surg 20: 41

    Google Scholar 

  9. Anand KJS, Sippell WG, Aynsley-Green A (1987) Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: Effects on the stress response. The Lancet 8527: 243

    Google Scholar 

  10. Anand KJS, Sippel WG, Schofield NM, Aynsley-Green A (1988) Does halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing operation? Br Med J 296: 668

    Google Scholar 

  11. Anand KJS, Sippell WG, Schofield NM, Aynsley-Green (1988) Does Halothane Anaesthesia Decrease the Metabolic and Endocrine Stress Response of Newborn Infants Undergoing Operation? Br Med J 296: 668

    Google Scholar 

  12. Arai K, Yanaihara T, Okinaga S (1976) Adrenocorticotropic hormone in human fetal blood at delivery. Am J Obstet Gynecol 125: 1136

    Google Scholar 

  13. Arant BS, Gooch WM (1978) Effects of acute hyperglycemia on the central nervous system of neonatal puppies. Pediatr Res 12: 549

    Google Scholar 

  14. Baird JD, Farquhar JW (1962) Insulin-secreting capacity in newborn infants of normal and diabetic women. lancet 1: 71

    Google Scholar 

  15. Bailey DR, Miller ED, Kaplan JA, Rogers PW (1975) The reninangiotensin aldosterone system during cardiac surgery with morphine-nitrous oxide anesthesia. Anesthesiol 42: 538

    Google Scholar 

  16. ballard FJ, Tomas FM, Pope LM, Hendry PG, james BE, MacMahon RA (1979) Muscle protein degradation in premature human infants. Clin Sci 57: 535

    Google Scholar 

  17. Barbul A (1986) Arginine: Biochemistry, physiology and therapeutic implications. JPEN 10: 227

    Google Scholar 

  18. Barbul A, Rettura G, Levenson MS, Barbul A, Rettura G, Levenson SM, Seifter E (1983) Wound healing and thymotropic effects of arginine: A pituitary mechanism of action. Am J Clin Nutr 37: 786

    Google Scholar 

  19. Benedict FG, Talbot FB (1915) The physiology of the newborn infant. Character and amount of the catabolism. Carnegie Inst Pub No. 233, Washington

  20. bent JM, Paterson JL, Mashiter K, Hall GM (1984) Effects of high-dose fentanyl anesthesia on the established metabolic and endocrine response to surgery. Anesthesia 39: 19

    Google Scholar 

  21. Bessey PQ, Watters JM, Aoki TT, Wilmore DW (1984) Combined hormonal infusion stimulates the metabolic response to injnjury. Ann Surg 200: 264

    Google Scholar 

  22. Beutler B, Cerami A (1987) Cachectin: More than a tumor necrosis factor. New Engl J Med 316: 379

    Google Scholar 

  23. Bogdonoff MD, Estes EH, Trout D (1959) Acute effect of physiologic stimuli upon plasma nonesterified fatty acid level. Proc Soc Exper Biol Med 100: 503

    Google Scholar 

  24. Boix-Ocha J, Martinez Ibanez V, Potau N, Lloret J (1987) cortisol response to surgical stress in neonates. Pediatr Surg Int 2: 267

    Google Scholar 

  25. Bougneres PF, Karl IE, Hillman LS, Bier DM (1982) Lipid transport in the human newborn: Palmitate and glycerol turnover and the contribution of glycerol to neonatal hepatic glucose output. J Clin Invest 70: 262

    Google Scholar 

  26. Bowie MD, Mulligan PB, Schwartz R (1963) Intravenous glucose tolrance in the normal newborn infant: The effects of a double dose of glucose and insulin. Pediatrics, Springfield 31: 590

    Google Scholar 

  27. Brandt M, Kehlet H, Shovsted L, Hansen JM (1976) Rapid decrease in plasma triodothyronine during surgery and epidural analgesia independent of afferent neurogenic stimuli and of cortisol. Lancet 2: 1333

    Google Scholar 

  28. Brandt MR, Fernandez A, Mordhurst R, Kehlet H (1978) Epidural analgesia improves postoperative nitrogen balance. Br Med J 1: 1106

    Google Scholar 

  29. Brandt MR, Olgaard K, Kehlet H (1979) Epidural analgesia inhibits the renin and aldosterone response to surgery. Acta Anesth Scand 23: 267

    Google Scholar 

  30. Bromage PR, Shibata HR, Willoughby HW (1971) Influence of prolonged epidural blockade on blood sugar and cortisol response to operations upon the upper part of the abdomen and thorax. Surg Gynecol Obstet 132: 1051

    Google Scholar 

  31. Bunker JP (1962) metabolic acidosis during anesthesia and surgery. Anesthesiol 23: 107

    Google Scholar 

  32. Burgoyne JL, Ballard FJ, Tomas FM, Dubozy A, MacLennan AH, Fitzgerald A, Dahlenburg AW (1982) Measurements of myofibrillar protein breakdown in newborn human infants. Clin Sci 63: 421

    Google Scholar 

  33. Christensen J, Kehlet H (1984) Postoperative fatigue and changes and nutritional status. Br J Surg 71: 473

    Google Scholar 

  34. Cochrane JPS (1978) The aldosterone response to surgery and the relationship of this response to post-operative sodium retention. Br J Surg 65: 744

    Google Scholar 

  35. Cohen MR, Pickar D, Dubois M (1983) Role of the endogenous opioid system in the human stress response. Psychiatr Clin N Amer 6: 457

    Google Scholar 

  36. Colle, Paulsen (1959) Response of the newborn infant to major surgery. I. Effects on water, electrolyte, and nitrogen balance. Pediatrics 23: 1063

    Google Scholar 

  37. Cooper GM, Holdcroft A, Hall GM, Alaghband-Zadeh J (1979) Epidural analgesia and the metabolic response to surgery. Canad Anaesthetic Soc J 26: 381

    Google Scholar 

  38. Coran AG (1986) Nutrition of the surgical patient. In: Welch (ed) Pediatric Surgery. Chapter 10, Yearbook Publishers, Fourth ed.

  39. Coran AG, Drongowski RA (1989) Body fluid compartment changes following neonatal surgery. J Ped Surg 24: 829

    Google Scholar 

  40. Cornblath M, Ganzon AF, Nicolopoulos D, Baens GS, Hollander RJ, Gordon MH, Gordon HH (1961) Studies of carbohydrate metabolism in the newborn infant. III. Some factors influencing the capillary blood sugar and the response to glucagon during the first hours of life. pediatrics 27: 378

    Google Scholar 

  41. Cuthbertson DP (1930) The disturbance of metabolism produced by bony and nonbony injury, with notes on certain abnormal conditions of bone. Biochem J 24: 1244

    Google Scholar 

  42. Cuthbertson DP (1942) Post-shock metabolic response. Lancet 1: 433

    Google Scholar 

  43. Cuthbertson DP (1959) Protein metabolism in relation to energy needs. metabolism 8: 787

    Google Scholar 

  44. DeLamater PV, Sperling MA, Fiser RH, Phelps D, Oh W, Fisher DA (1974) Plasma alanine: relation to plasma glucose, glucagon and insulin in the neonate. J Pediatrics 85: 702

    Google Scholar 

  45. DeMaria EJ, Lilly MP, Gann DS (1987) Potentiated hormonal responses in a model of traumatic injury. J Surg Res 43: 45

    Google Scholar 

  46. Deitch EA, Xu D, McIntyreBridges R (1988) Opioids modulate human neutrophil and lymphocyte function: Thermal injury alters plasma B-endorphin levels. Surgery 104: 41

    Google Scholar 

  47. Dole VP (1956) A relation between non-esterified fatty acids in plasma and the metabolism of glucose. J Clin Invest 35: 150

    Google Scholar 

  48. Dubois M, Pickar D, Cohen M, Roth YF, MacNamara TF, Bunney WE (1981) Surgical stress in humans is accompanied by an increase in plasma B-endorphin immunoreactivity. Life Sci 29: 1249

    Google Scholar 

  49. Duke JH, Jorgensen SB, Broell JR, Long CL, Kinney JM (1970) Contribution of protein to caloric expenditure following injury. Surgery 68: 168

    Google Scholar 

  50. Duffy B, Pencharz P (1986) The effects of surgery on the nitrogen metabolism of parenterally fed human neonates. ped Res 20: 32

    Google Scholar 

  51. Eigler N, Sacca L, Sherwin RS (1979) Synergisticc interactions of physiologic increments of glucagon, epinephrine and cortisol in the dog. J Clin Invest 63: 114

    Google Scholar 

  52. Elliot M, Albert KGMM (1983) The hormonal and metabolic response to surgery and trauma. In: Kleinberger G, Deutsch E (eds) New aspects of clinical nutrition. Karger, Basel, p 247

    Google Scholar 

  53. Elphick MC (1972) Some aspects of fat and carbohydrate metabolism in the newborn. PhD Thesis, London

  54. Elphick MC, Wilkinson AW (1968) Glucose intolerance in newborn infants undergoing surgery for alimentary tract anomalies. Lancet 539

  55. Elphick MC, Wilkinson AW (1981) The effects of starvation and surgical injury on the plasma levels of glucose, free fatty acids, and neutral lipids in newborn babies suffering from various congenital anomalies. Ped Res 15: 313

    Google Scholar 

  56. Enquist A, Blichert-Toft M, Olgaard K, Brandt MR, Kehlet H (1978) Inhibition of aldosterone response to surgery by saline administration. Brit J Surg 65: 224

    Google Scholar 

  57. Felig P, Pozefsky T, Marliss E, Cahill GF (1970) alanine: key role in gluconeogenesis. Science 167: 1003

    Google Scholar 

  58. Finberg L (1967) Dangers to infants caused by changes in osmolal concentration. Pediatrics 40: 1031

    Google Scholar 

  59. Finley RJ, Inculet RI, Pace R, Holliday R, Rose C, Duff JH, Groves AC, Woolf LI (1986) Major operative trauma increases peripheral amino acid release during the steady-state infusion of total parenteral nutrition in man. Surgery 99: 491

    Google Scholar 

  60. Fiselier T, Monnens L, Moerman E, Van Muster P, Jansen M, Peer P (1983) Influence of the stress of venipuncture on basal levels of plasma renin activity in infants and children. Int J Pediatr Nephrol 4: 181

    Google Scholar 

  61. Fomon SJ, Haschke F, Zeigler EE, Nelson SE (1982) Body composition of reference children from birth to age 10 years. Am J Clin Nutr 35: 1169

    Google Scholar 

  62. Foster KJ, alberti KGMM, Binder C, Hinks L, Karran SJ, Orskov H, Smythe P, Talbot S, Turnell D (1979) Lipid metabolites and nitrogen balannce after abdominal surgery in man. Br J Surg 66: 242

    Google Scholar 

  63. Furman WL, Menke JA, Barson WJ, Miller RR (1984) Continuous naloxone infusion in two neonates with septic shock. J Pediatr 105: 649

    Google Scholar 

  64. Gann DS, Lilly MP (1983) The neuroendocrine response to multiple trauma. World J Surg 7: 101

    Google Scholar 

  65. Gautray JP, Jolivet A, Vielh JP, Guillemin R (1979) Presence of immunoassayable beta-endorphin in human amniotic fluid: Elevation in cases of etal distress. Am J Obstet Gynecol 129: 211

    Google Scholar 

  66. Gordon RS, Cherkes A (1956) Unesterified fatty acid in human blood plasma. J Clin Invest 35: 206

    Google Scholar 

  67. Greenwall MJ, Kettlewell MGW, Gough MH (1983) Nitrogen requirements for postoperative parenteral nutrition in neonates. Acta Therapeutica 9: 5

    Google Scholar 

  68. Grewal RS, Mampilly J, Misra TR (1969) Postoperative protein metabolism and electrolyte changes in pediatric surgery. Int Surg 51: 142

    Google Scholar 

  69. Gunnar MR, Malone S, Vance G, Fisch RO (1985) Coping with aversive stimulation during the neonatal period: Quiet sleep and plasma cortisol levels during recovery from circumcision. child Devlp 56: 824

    Google Scholar 

  70. Hahn P, Kddovsky O (1966) Utilization of nutrients during post-natal development. Oxford, p 78

  71. Halter JB, Pflug AE, Porte D (1977) Mechanism of plasma catecholamine increases during surgical stress in man. J Clin Endocrinol Metab 45: 936

    Google Scholar 

  72. Hansen JDL, Smith CA (1953) Effects of withholding fluid in the immediate post-natal period. Pediatrics 12: 99

    Google Scholar 

  73. Heard CRC, Stewart RJC (1960) Protein malnutrition and disorders of the endocrine glands: Biomchemical changes. Acta Endocrinol Suppl 51: 1277

    Google Scholar 

  74. Hillman DA, Giroud CJ (1965) Plasma cortisone and cortisol levels at birth and during the neonatal period. J Clin Endocrinol Metab 25: 243

    Google Scholar 

  75. Hindmarsh KW, Sankaran K (1985) Endorphins and the neonate. Can Med Assoc J 132: 331

    Google Scholar 

  76. Hindmarsh KW, Sankaran K, Watson VG (1984) Plasma beta-endorphin concentrations in neonates associated with accute stress. Dev Pharmacol Ther 7: 198

    Google Scholar 

  77. Hughes EA, Stevens LH, Wilkinson AW (1964) Some aspects of starvation in the newborn baby. Arch Dis Child 39: 598

    Google Scholar 

  78. Hughes EA, Stevens LH, Toms DA, Wilkinson AW (1965) Esophageal atresia: Metabolic effects of operation. Br J Surg 52: 403

    Google Scholar 

  79. Hulton N, Johnson DJ, Smith RJ, Wilmore DW (1985) Hormonal blockade modifies post-traumatic protein catabolism. J Surg Res 39: 310

    Google Scholar 

  80. Hume DM, Egdahl RH (1959) The importance of the brain in the endocrine response to injury. Ann Surg 150: 697

    Google Scholar 

  81. Im MJC, Hoopes JE (1970) Energy metabolism in healing skin wounds. J Surg Res 10: 459

    Google Scholar 

  82. Ito T, Iyomasa Y, Inoue T (1976) Changes o the postoperative minimal oxygen consumption of the newborn. J Ped Surg 11: 495

    Google Scholar 

  83. Johnston UDA (1964) Endocrine aspects o the metabolic response to surgical operation. Ann R. Coll Surg Engl 35: 270

    Google Scholar 

  84. Kalahan SC, C'Angeleo LJ, Savin S, Adam PAJ (1979) Glucose production in pregnant women at term gestation: Sources of glucose for human fetus. J CLin Investig 63: 388

    Google Scholar 

  85. Kalhan SC, Bier DM, Savin SM, Adam PAJ (1980) Estimation of glucose turnover and 13C recycling in the human newborn by simultaneous [1-13C] glucose and [6,6-2H2] glucose tracers. J clin Endocrinol Metab 50: 456

    Google Scholar 

  86. Kehlet H (1979) Stress-free anaesthesia and surgery. Acta Anesthes Scand 23: 503

    Google Scholar 

  87. Kehlet H, Brandt MR, Hansen AP, Alberti KGMM (1979) Effect of epidural analgesia on metabolic profiles during and after surgery. Brit J Surg 66: 543

    Google Scholar 

  88. Kerri-Szanto M (1983) Demand analgesia. Br J Anesthesia 55: 919

    Google Scholar 

  89. Kinney JM, Duke JH, Long CL, Gump FE (1970) Tissue fuel and weight loss after injury. J Clin Path 23: 65

    Google Scholar 

  90. Kirya C, Ertthmann MW (1978) Neonatal circumcision and penile dorsal nerve blbock: A painless procedure. J Pediatr 96: 998

    Google Scholar 

  91. Knutrud O (1965) The water and electrolyte metabolism in the newborn child after major surgery. Scandinavian University Books, Universitetsforlaget, oslo, Norway

    Google Scholar 

  92. Kostyo JL, Keagan CR (1976) The biology of growth hormone. Pharmacol Ther 2: 591

    Google Scholar 

  93. Kusaka M, Ui M (1977) Activation of the cori cycle by epinephrine. Am J Physiol 232: E145

    Google Scholar 

  94. Marliss EB, Murray FT, Nakhooda AF (1978) The metabolic response to hypocaloric protein diets in obese men. J Clin Invest 62: 468

    Google Scholar 

  95. Marsac C, Saudubray JM, Moncion A, Leroux JP (1976) Development of gluconeogenic enzymes in the liver of human newborns. Biol Neonate 28: 317

    Google Scholar 

  96. McCance RA, Strangeways WMB (1954) Protein catabolism and oxygen consumption during starvation in infants, young adults and old men. Br J Nutr 8: 21

    Google Scholar 

  97. McIntosh TK, Bush HL, Palter M, McIntosh TK, Bush HL, Palter M, Hay JR, Aun F, Yeston NS, Egdahl RH (1985) Prolonged disruption of plasma beta-endorphin dynamics following surgery. J Surg Res 38: 210

    Google Scholar 

  98. McMenamy RH, Birkhahn R, Oswald G, Reed R, Rumph C, Vaidyanath N, Yu L, Cerra FB, Sorkness R, Border JR (1981) Multiple systems organ failure: I. The basal state. J Trauma 21: 99

    Google Scholar 

  99. Meguid MM, Brannan MF, Aoki TT, Muller Wa, Ball MR, Moore FD (1974) Hormone-substrate interrelationships following trauma. Arch Surg 109: 776

    Google Scholar 

  100. Michie HR, Spriggs DR, Manogue KR, Sherman ML, Revhaug A, O'Dwyer SJ, Arthur K, Dinarello CA, Cerami A, Wolff SM, Kufe DW, Wilmore DW (1988) Tumor necrosis factor and endotoxin induce similar metabolic responses in human beings. Surgery 104: 280

    Google Scholar 

  101. Mills NL, Beaudet RL, Isom OW, Spencer FC (1973) Hyperglycaemia during cardiopulmonary bypass. Ann Surg 177: 203

    Google Scholar 

  102. Milne EMG, Elliott MJ, Pearson DT, Holden MP, Orskov H, Alberti KGMM (1986) The effect on intermediary metabolism of open-heart surgery with deep hypothermia and circulatory arrest in infants of less than 10 kilograms body weight. Perfusion 1: 29

    Google Scholar 

  103. Moyer E, Cerra F, Chenier R, Peters D, Oswald G, Watson F, Yu L, McMenamy RH, Border JR (1981) Multiple systems organ failure. VI. Death predictors in the trauma-septic state- the most critical determinants. J Trauma 21: 862

    Google Scholar 

  104. Mulloy AL, Kari FW, Visek WJ (1982) Dietary arginine, insulin secretion, gluccose tolerance and liver lipids during repletion of protein depleted rats. Horm Metab Res 14: 471

    Google Scholar 

  105. Nakai T, Yamada R (1978) The secretion of catecholamines in newborn babies with special reference to fetal distress. J Perinat Med 6: 39

    Google Scholar 

  106. Newsome HH, Rose JC (1971) The response of adrenocorticotrophic hormone and growth hormone to surgical stress. J Clin Endocrinol 33: 481

    Google Scholar 

  107. Novak M, Melichar V, Hahn P, Koldovsky O (1961) Levels of lipids in the blood of newborn infants and the effect of glucose administration. Physiol Bohemoslov 10: 488

    Google Scholar 

  108. Ogata ES, Foung SKH, Holliday MA (1978) The effects of starvation and refeeding on muscle protein synthesis and catabolism in the young rat. Journal of Nutrition 108: 759

    Google Scholar 

  109. Oppenheim WL, Williamson DH, Smith R (1980) Early biochemical changes and severity of injury in man. J Trauma 20: 135

    Google Scholar 

  110. Persson B, Gentz J (1966) The pattern of blood lipids, glycerol and ketone bodies during the neonatal period, infancy and childhood. Acta Pediatr Scand 55: 353

    Google Scholar 

  111. Pinter A (1973) The mtabolic effects of anesthesia and surgery in the newborn infant. Zeitschrift für Kinderchirurgie 12: 149

    Google Scholar 

  112. Pinter A (1975) Metabolic changes in newborn infants following surgical operations. Acta Ped Acad Sci Hungary 16: 171

    Google Scholar 

  113. Prescott RWG, Yeo PPB, Watson MJ, Johnston PDA, Ratcliffe JG, Everod DC (1979) Total and free thyroid hormone concentrations following elective surgery. J clin Path 32: 321

    Google Scholar 

  114. Rackow H, Salanitre E, Green LT (1961) Frequency of cardiac arrest associated with anesthesia in infants and children. Pediatrics 28: 697

    Google Scholar 

  115. Randle PJ, Garland PB, Hales CN, Newsholme EA (1963) The glucose fatty-acid cycle: its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet 1: 785

    Article  CAS  PubMed  Google Scholar 

  116. Reisner SH, Aranda JV, Colle E, Parageorgiou A, Schiff D, Scriver CR, Stern L (1973) The effect of intravenous glucagon on plasma amino acids in the newborn. Pediatr Res 7: 184

    Google Scholar 

  117. Rich AJ, Wright PD (1979) Ketosis and nitrogen excretion in undernourished surgical patients. JPEN 3: 350

    Google Scholar 

  118. Rickham PP (1957) The metabolic response to neonatal surgery. Harvard University Press, Cambridge, MA

    Google Scholar 

  119. Robertson D, Michelakis AM (1972) Effect of anesthesia and surgery on plasma renin activity in man. J Clin Endocrinol Metab 34: 831

    Google Scholar 

  120. Ross H, Johnston IDA, Welborn TA, Wright AD (1966) Effect of abdominal operation on glucose tolerance and serum levels of insulin, growth hormone and hydrocortisone. Lancet 2: 563

    Google Scholar 

  121. Russel RCG, Walker CJ, Bloom SR (1975) Hyperglucagonaemia in the surgicl patient. Br Med J 1: 10

    Google Scholar 

  122. Ryan NT (1976) Metabolic adaptations for energy production during trauma and sepsis. Surg clin North Am 56: 1073

    Google Scholar 

  123. Saito H, Trocki O, Wang S, Gonce SJ, Joffe SN, Alexander JW (1987) Metabolic and immune effects of dietary arginine supplementation after burn. Arch Surg 122: 784

    Google Scholar 

  124. Schweiss JF, Pennington DG (1981) Anesthetic management of neonates undergoing pallative operations for congenital heart defects. Clev Clin Quart 48: 153

    Google Scholar 

  125. Seashore JH, Huszar G, Davis EM (1981) Urinary 3-methylhistidine/creatinine ratio as a clinical tool: Correlation between 3-methylhistidine excretion and metabolic and clinical states in healthy and stressed premature infants. metabolism 30: 959

    Google Scholar 

  126. Shamoon H, Hendler R, Sherwin RS (1981) Synergistic interactions among antiinsulin hormones in the pathogenesis of stress hyperglycemia in humans. J Clin Endocrinol Metab 52: 1235

    Google Scholar 

  127. Sheeley HJ (1961) Glycogen reserves and their changes at birth and in anoxia. Br Med Bull 17: 137

    Google Scholar 

  128. Shelley HJ (1964) Carbohydrate reserves in the newborn infant. Br Med J 1: 273

    Google Scholar 

  129. Sitren HS, Fisher H (1977) Nitrogen retention in rats fed on diets enriched with arginine and glycine: I. Improved N retention after trauma. Br J Nutr 37: 195

    Google Scholar 

  130. Solomon S, Bird CE, Ling W, Iwamiya M, Young PCM (1967) formation and metabolism of steroids in the fetus and placenta. recent Progr Horm Res 23: 297

    Google Scholar 

  131. Sperling MA (1982) Integration of fuel homeostasis by insulin and glucagon in the newborn. Mongr Pediatr 16: 39

    Google Scholar 

  132. Stang HJ, Gunnar MR, Snellman L, Condon LM, Kestenbaum R (1988) Local anesthesia for neonatal circumcision. Effects on distress and cortisol response. JAMA 259: 1507

    Google Scholar 

  133. Steinberg D (1963) Fatty acid mobilization-Mechanisms of regulation and metabolic consequences. In: JK Grant (ed) The control of lipid metabolism. Academic Press, New York p 111

    Google Scholar 

  134. Steinberg D (1966) Catecholamine stimulation of fat mobilization and its metabolic consequences. Pharmacol Reviews 18: 217

    Google Scholar 

  135. Steinberg D, Khoo JC (1977) Hormone sensitive lipase of adipose tissue. Fed Proc 36: 1986

    Google Scholar 

  136. Stjernstrom H, Jorfeldt L, Wiklund L (1981) The influence of abdominal surgical trauma upon the turnover of some blood borne metabolites in the human leg. JPEN 5: 207

    Google Scholar 

  137. Studley HO (1936) Percentage of weight loss. A basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 106: 458

    Google Scholar 

  138. Suits GS, Bottsford JE Jr (1987) The metabolic response to trauma. Resident and Staff Physician 33: 21

    Google Scholar 

  139. Sukarochano K, Motai Y, Slim M, Shepard R, Kiesewetter WB (1965) Postoperative protein metabolism in Pediatric Surgery. Surg Gynecol Obstet 121: 79

    Google Scholar 

  140. Talbert JL, Karmen A, Graystone JE, Haller JA, Cheek DB (1967) Assessment of the infants response to stress. Surgery 61: 626

    Google Scholar 

  141. Talbert LM, Kraybill EN, Potter HD (1976) Adrenal cortical response to circumcision in the neonate. Obstet Gynecol 48: 208

    Google Scholar 

  142. Tomas FM, Ballard FJ, Pope LM (1979) Age dependent changes in the rate of myofibrillar protein degradation in humans as assessed by 3-methylhistidine and urinative excretion. Clinical Science 56: 341

    Google Scholar 

  143. Valman HB, Pearson JF (1980) What the fetus feels. Br Med J 280: 233

    Google Scholar 

  144. Van Loon GR, Appel NM, Ho D (1981) B-endorphin induced stimulation of central sympathetic outflow: b-endorphin increases plasma concentrations of epinephrine, norepinephrine, and dopamine in rats. Endocrinology 109: 46

    Google Scholar 

  145. Vaughan M, Steinberg D (1963) Effect of hormones on lipolysis and esterification of free fatty acids during incubation of adipose tissue in vitro. J Lipid Res 4: 193

    Google Scholar 

  146. Wadstrom LB (1959) Plasma lipids and surgical trauma: A methodological, experimental and clinical study. Acta Chir Scand Suppl 238: 1

    Google Scholar 

  147. Walsh ES, Traynor C, Paterson JL, Hall GM (1983) Effect of different intraoperative fluid regimenson circulating metabolites and insulin during abdominal surgery. Br J Anaesth 55: 135

    Google Scholar 

  148. Wannemacher RW, Dinterman RE (1977) Total body protein catabolism in starved and infected rats. Am J Clin Nutr 30: 1510

    Google Scholar 

  149. Ward HC, Halliday S, Sim AJW (1987) Protein nd energy metabolism with biosynthetic human growth after gastrointestinal surgery. Anals of Surg 206: 56

    Google Scholar 

  150. Watters JM, Bessey PQ, Dinarello CA, Wolff SM, Wilmore DM (1986) Both inflammatory and endocrine mediators stimulate host response to sepsis. Arch Surg 121: 179

    Google Scholar 

  151. Widdowson EM, Spray CM (1951) Chemical development in-utero Arch Dis Child 26: 205

    Google Scholar 

  152. Wilkinson AW, Hughes EA, Stevens LH (1965) Neonatal duodenal obstruction. The influence of treatment on the metabolic effects of operation. Br J Surg 52: 410

    Google Scholar 

  153. Williamson JR (1976) In Hanson, Mehlman, Gluconeogenesis, its regulation in mammalian species, New York, Wiley p 165

    Google Scholar 

  154. Williamson DH (1981) Regulation of ketone body metabolism and the effects of injury. ACTA Chir Scand 52 (Suppl 507): 22

    Google Scholar 

  155. Williamson DH (1982) The production and utilization of ketone bodies in the neonate: In Jones (ed) Biochemical development of the fetus and neonate. Amsterdam, Elsevier, p 621

    Google Scholar 

  156. Williamson PS, Williamson ML (1983) Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 71: 36

    Google Scholar 

  157. Williamson PS, Evans ND (1986) Neonatal cortisol response to circumcision with anesthesia. Clin Pediatr 25: 412

    Google Scholar 

  158. Williamson DH, Farrell R, Kerr A, Smith R (1977) Muscle-protein catabolism after injury in man, as measured by urinary excretion of 3-methyl histidine. Clin Sci Mol Med 52: 527

    Google Scholar 

  159. Wilmore DW (1976) Hormonal responses and their effect on metabolism. Symposium on response to infection and injury II. Surg Clin North Amer 56: 999

    Google Scholar 

  160. Wilmore DW (1981) Glucose metabolism following severe injury. J Trauma 21: 705

    Google Scholar 

  161. Winters AJ, Oliver C, Colston C, MacDonald PC, Porter JC (1974) Plasma ACTH levels in the human fetus and neonate as related to age and paturition. J Clin Endocrinol Metab 39: 269

    Google Scholar 

  162. Winthrop AL, Jones PJH, Schoeller DA, Filler RM, Heim T (1987) Changes in the body composition of the surgical infant in the early postoperative period. J Ped Surg 22: 546

    Google Scholar 

  163. Wolfe BM, Culebras JM, Aoki TT, O'Connor NE, Finley FJ, Kaczowka A, Moore FD (1979) The effect of glucagon on protein metabolism in normal man. Surgery 86: 248

    Google Scholar 

  164. Wolfe RR, Herndon DN, Jahoor F, Miyosji H, Wolfe M (1987) Effect of severe burn injury on substrate cycling by glucose and fatty acids. NEJM 317: 403

    Google Scholar 

  165. Wolfe RR, Herndon DN, Peters EJ, Jahoor F, Desai MH, Holland OB (1987) Regulation of lipolysis in severely burned children. Annals Surg 206: 214

    Google Scholar 

  166. Wright PD, Johnston IDA (1975) The effects of surgical operation on growth hormone levels in plasma. Surgery 77: 479

    Google Scholar 

  167. Wright PD, Henderson K, Johnston IDA (1974) glucose utilization and insulin secretion during surgery in man. Br J Surg 61: 5

    Google Scholar 

  168. Young VR, Munro HN (1978) N T-methylhistidine (3-methylhistidine) and muscle protein turnover; an overview. Fed Proc Fed Am Soc Exp Biol 37: 2291

    Google Scholar 

  169. Zlotkin SH (1984) Intravenous nitrogen intake requirements in full-term newborns undergoing surgery. Pediatrics 73: 493

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Michigan Hospitals, Ann Arbor, Michigan, USA

    David J. Schmeling

  2. Section of Pediatric Surgery, University of Michigan Medical School. C. S. Mott Children's Hospital, 48109-0245, Ann Arbor, MI, USA

    Arnold G. Coran

Authors
  1. David J. Schmeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnold G. Coran
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

From the Section of Pediatric Surgery, C. S. Mott Children's Hospital and University of Michigan Medical School

Offprint requests to: A. G. Coran

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmeling, D.J., Coran, A.G. The hormonal and metabolic response to stress in the neonate. Pediatr Surg Int 5, 307–321 (1990). https://doi.org/10.1007/BF00177096

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00177096

Keywords

Search

Navigation