I’ve been thinking more about newborns and how their circadian rythyms would dictate cortisol levels and GH.  From all the studies done, we know that in the first part of sleep the child’s cortisol levels are at their lowest.  In the second part of sleep and when they wake they are stimulated.

As newborns are sleeping a lot of the time and this can be up to 16 hours a day that should surely mean that normal healthy babies are rleasing GH when they are asleep?  Also when they wake for a feed, their cortisol levels must be at their highest.  So when they wake they need cortisol to be high and when they sleep it needs to be low.  I get the impression that if they took levels of blood they would see a zig zag throughout the whole of a 24 hour period where cortisol and 17 OHP was concerned or GH.  They generally only wake when they want to be fed in the first weeks.

They in fact can wake anything from 5-8 times per day for a feed and have very short wakeing periods.  To my mind the very large two times a day dosing and three times a day dosing is primative where they are concerned therefore.  The more periods of sleep should surely add up to the more doses?  It would make complete sense to me to dose a tiny baby everytime they woke up with a small dose of cortisol.  Samll being something like 0.25mg.  Of course that is only achievable with suspension or from 1mg tablets.

When newborns are wake they are more likely also to cry and grizzle, and so their waking periods are most likely where they need their hydrocortisone dose really.  So instead of say giving say 1.5mg - 2.5mg twice per day OR 1mg - 1.5mg three times per day, why can’t we give them a very tiny dose of say 0.25mg, 0.50mg or 1mg everytime they wake up on the dot? (Depending upon their size and periods of asleep in a day). The reason I say this is as a baby get’s bigger, they also coincidentally sleep less during the day, so this means their dosing times would become less and their doses would need to stretch for longer which would facilitate each dose becoming bigger also to meet the need.  Until they finally slept through and were more or less in a good similar routine to ourselves whereby you could then have 3 -4 times per day dosing as in the abstract given.  

I am sure with such small doses that they will peak and decline rapidly in the blood and facilitate or mimick what I think happens for a newborn baby during a 24 hour period where cortisol and GH is concerned.

Not meaning to confuse new parents of course, I am just questioning the method of dosing for very small babies.   At present Doctors seem to give less doses as opposed to more doses when they are tiny babies and in large amounts which I feel given the way things work now is not the way a small baby would make cortisol. 

I know that the acceptable 17 OHP ranges are higher the younger a child is, but surely they can achieve that with giving the minute doses more frequently--so that exposure to that 17 OHP is mimicking the similar way it would naturally as opposed to two large peaks of it in the day where androgens may start to be made?