Bibian van der Voorn

21 PRETERM GLUCOCORTICOID PROGRAMMING ENDOGENOUS GLUCOCORTICOID SENSITIVITY In the challenging situation of very preterm birth, carriage of (sets of) genes that promote the response to vasopressors and/or the release of stored fuels may be beneficial. Indeed, there are some preliminary data to suggest that GR variants influencing cortisol sensitivity are related to the presence of several neonatal morbidities in babies with VLBW, albeit not consistently 99 . On the other hand, later in life, traits rendering increased glucocorticoid signaling were suggested to exacerbate the impact of antenatal glucocorticoids on the risk of developing adverse outcomes after very preterm birth, such as metabolic perturbations and poorer cognitive capabilities 81,100 . CONCLUSIONS Glucocorticoids, given their impact on blood pressure regulation and energy homeostasis, offer resilience to potentially life-threatening conditions after very preterm birth. Adaptation of HPA axis activity to the increased requirements of unintended postnatal life seems to be an attractive coping mechanism. It is suggested that once the burdens of neonatal life are no longer present, the HPA axis continues to be upregulated, leading to alterations in growth and developmental pathways, and, ultimately, to deleterious health consequences.