Neonatal Infant Stressor Scale Research Articles

Stress and self-regulation behaviors in preterm neonates hospitalized at open-bay and single-family room Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) could be a risk factor for the development of preterm neonates due to the stressful procedures they undergo. Stress-related behaviors must be managed through environmental strategies that support regulating the neonates' biobehavioural system to minimize the negative impact on their development. The study aimed to compare the NICU environment's stressful procedures and developmental care strategies and the stress and self-regulation behaviors of preterm neonates in groups differentiated by the NICU environmental design. The sample comprised 20 preterm neonates hospitalized in a NICU with an open-bay model (OB NICU) and 20 preterm neonates hospitalized in a single-family room model (SFR NICU). The stressful procedures were assessed by the Neonatal Infant Stressor Scale (NISS). The developmental care strategies and the preterm neonates' stress and self-regulation behaviors were assessed using a structured observational protocol. The between-group comparison was performed by the Mann-Whitney test, and the significance level was set at 5%. Both NICUs had similar stressful procedures and developmental care approaches. However, the preterm neonates hospitalized in the SFR NICU exhibited significantly fewer total stress behaviors, and specifically in the motor system, compared to those in the OB NICU. Additionally, the preterm neonates hospitalized in the SFR NICU exhibited significantly more total self-regulation behaviors, and specifically in the behavioral state system, compared to those in the OB NICU. The findings showed that the single-family room NICU model was consistent with the environmental protection of biobehavioural regulation in preterm neonates hospitalized in the NICU.

Early stress during NICU stay and parent-reported health-related quality of life after extremely preterm birth: an exploratory study with possible targets for early intervention.

The association between neonatal intensive care unit (NICU) related stress in preterm infants and their health-related quality of life (HRQoL) in the first year following preterm birth remains unexplored. Understanding this association is crucial for enhancing preventive and supportive measures for infants and parents within and beyond the NICU. From a single center observational cohort study, we included infants with gestational ages below 30 weeks and/or birth weights under 1,000 grams. HRQoL was quantified using the Infant Quality of Life Instrument (IQI) at 3-, 6-, 9- and 12-months corrected age, covering seven domains. NICU stress was quantified using the Neonatal Infant Stressor Scale (NISS) for the first week of life. We performed Spearman's correlation analyses to test this association. Of the 45 included infants, the IQI was completed for 27 (60%) at 3, 15 (33%) at 6, 14 (31%) at 9 and 15 (33%) at 12 months. The HRQoL sum scores were related to neonatal stress at 9 and 12 months (ρ = 0.643 and 0.591, p = 0.013 and p = 0.019, respectively) but not at 3 and 6 months (ρ = -0.001 and -0.077 respectively, p > 0.05). Higher NICU stress tended to be associated with more respiratory and mood problems throughout the first year. From a parental perspective on infant HRQoL, extremely preterm infants with higher stress exposure show more problems in the second half-year of life, mainly breathing and possibly mood-related problems. This knowledge may help improve our neonatal care, both during NICU stay and in follow-up clinics, by implementing targeted interventions.

Health disparities in preterm births.

Black African American (B/AA) women have a 2-fold to 3-fold elevated risk compared with non-Hispanic White (W) women for preterm birth. Further, preterm birth is the leading cause of mortality among B/AA infants, and among survivors, preterm infant adverse health outcomes occur disproportionately in B/AA infants. Racial inequities in maternal and infant health continue to pose a public health crisis despite the discovery >100 years ago. The purpose of this study was to expand on reported preterm infant outcome disparities. A life-course approach, accumulation of lifelong stress, including discrimination, may explain social factors causing preterm birth rate and outcome inequities in B/AA mothers. Anthropometric measures and clinical treatment information for 197 consented participants were milled from electronic health records across 4 years. The Neonatal Infant Stressor Scale was used to tally acute and chronic painful/stressful procedures. Neurobehavioral differences were investigated using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. B/AA mothers gave birth to preterm infants earlier than W mothers. NICU hospitalization stays were extended more than 2 weeks for the significantly smaller B/AA preterm infants in comparison to the age-matched W preterm infants. A higher number of chronic lifesaving procedures with demonstrated altered stress response patterns were recorded for B/AA preterm infants. This cross-sectional analysis of preterm birth rates and preterm infant developmental and neurodevelopmental outcomes are presented in the context of NICU stress and pain, with attendant implications for infant mortality and future health disparities. Preterm birth rate and outcome inequities further support the need to develop interventions and policies that will reduce the impact of discrimination and improve social determinants of health for Black, Indigenous, and other People of Color.

Neonatal stress exposure and DNA methylation of stress-related and neurodevelopmentally relevant genes: An exploratory study

BackgroundStress exposure during Neonatal Intensive Care Unit (NICU) stay may have long-lasting effects on neurodevelopmental outcomes in extremely preterm infants. Altered DNA methylation of stress-related and neurodevelopmentally relevant genes may be an underlying mechanism. AimsThis exploratory study aimed to investigate the association between neonatal stress exposure and DNA methylation in these genes at two different time points: early during the NICU stay (7–14 days after birth) and later, at discharge from the NICU. SubjectsWe included 45 extremely preterm infants in this prospective cohort study, gestational age 24–30 weeks. Outcome measuresWe collected fecal samples at days 7–14 (n = 44) and discharge (n = 28) and determined DNA methylation status in predefined regions of NR3C1, SLC6A4, HSD11B2, OPRM1, SLC7A5, SLC1A2, IGF2, NNAT, BDNF and GABRA6 using pyrosequencing. Because of low DNA concentrations in some fecal samples, we could do so in 25–50 % of collected samples. We prospectively quantified daily neonatal stress exposure using the Neonatal Infant Stressor Scale (NISS) and explored associations between cumulative NISS scores and average DNA methylation status. ResultsRates of methylation of most genes were not statistically different between day 7–14 and discharge, except for OPRM1. We found moderately high and mostly negative correlation coefficients upon discharge with the cumulative NISS for the NR3C1, SLC6A4, SLC1A2, IGF2, BDNF and OPRM1 genes, albeit not statistically significant. ConclusionsFindings suggest that expression of stress-related and neurodevelopmentally relevant genes may be differently regulated following higher neonatal stress exposure. Larger studies should challenge the findings of this study and ideally test the effects on gene expression.

The relationship between NICU stress and neurodevelopmental outcomes of preterm infants: A multi-center prospective cohort study in China

PurposeTo examine the relationship between NICU stress exposure and the neurodevelopmental outcomes of preterm infants. Design and methodsA multicenter, prospective cohort study was conducted between May 2021 and June 2022. Preterm infant participants (28–34 weeks gestational age) were recruited at birth from three NICUs of three tertiary hospitals by convenience sampling. The NICU stress includes acute NICU stress and chronic NICU stress which were measured over the total NICU hospitalization for each infant using the Neonatal Infant Stressor Scale (NISS). Neurodevelopmental outcomes of preterm infants were assessed at 3 months corrected age (CA) using the Ages and Stages Questionnaire, Third Edition (ASQ-3). ResultsOf one hundred and thirty preterm infant participants, 108 preterm infants were included into analysis. Results showed that acute NICU stress exposure significantly predicted the neurodevelopmental abnormalities in communication function (RR: 1.001, 95%CI: 1.000–1.001, p = .011), while chronic NICU stress exposure was significantly associated with the problem-solving function (RR: 1.003, 95%CI: 1.001–1.005, p = .002) at 3 months CA. No significant associations were found between NICU stress exposure and other dimensions of neurodevelopmental outcomes, including gross motor, fine motor, and personal-social functions. ConclusionNICU stress exposure demonstrated a significant predicting relationship with abnormalities in communication and problem-solving functions of preterm infants at 3 months CA. Practice implicationsDuring the NICU hospitalization, neonatal health caregivers should systematically monitor the NICU stress exposure to prevent neurodevelopmental problems in preterm infants.

Neonatal stress and behavior problems in preschool children born preterm.

The aim of the present longitudinal study was to examine the effect of preterm childbirth, acute neonatal stress, and child behavior at 18-36months of age on later behavior outcomes in 4-5-year-old children. The sample comprised of 70 children who were born preterm. The neonatal characteristics of children were assessed during hospitalization by reviewing their medical records and utilizing the Neonatal Infant Stressor Scale. Behavior problems were evaluated by the maternal-report in the Child Behavior Checklist 1½-5years. A multiple linear regression analysis was conducted. Also, the repeated measures analysis of variance and the McNemar test for paired samples were performed. Daily exposure of the infants to high neonatal acute stress during NICU hospitalization and more behavior problems at 18-36months of age was associated with more total and externalizing behavior problems at 4-5years of age. Lower gestational age at childbirth and more internalizing behavior problems at 18-36months was associated with more internalizing problems at 4-5years old. The present study showed the combination of predictors of neonatal conditions and behavioral problems at childhood, highlighting the relevance of the implementation of developmental care in the NICU and follow-up the preterm infants after discharge programs.

Early-life factors associated with neurobehavioral outcomes in preterm infants during NICU hospitalization.

The aim of this study was to investigate the influence of early-life pain/stress and medical characteristics on neurobehavioral outcomes in preterm infants. A prospective cohort study was conducted with 92 preterm infants (28-32 weeks gestational age [GA]). Early-life pain/stress was measured via the Neonatal Infant Stressor Scale (NISS) during the first 28 days of NICU hospitalization. Neurobehavioral outcomes were evaluated using the NICU Network Neurobehavioral Scale at 36-38 weeks post-menstrual age. Functional regression and machine learning models were performed to investigate the predictors of neurobehavioral outcomes. Infants experienced daily acute pain/stress (24.99 ± 7.13 frequencies) and chronic events (41.13 ± 17.81 h). Up to 12 days after birth, both higher acute and chronic NISS scores were associated with higher stress scores; and higher chronic NISS scores were also related to lower self-regulation and quality of movement. Younger GA predicted worse neurobehavioral outcomes; GA < 31.57 weeks predicted worse stress/abstinence, self-regulation, and excitability; GA < 30.57 weeks predicted poor quality of movement. A higher proportion of maternal breastmilk intake predicted better self-regulation, excitability, and quality of movement in older GA infants. Preterm infants are vulnerable to the impact of early-life pain/stress. Neurobehavioral outcomes are positively associated with increased GA and higher maternal breastmilk intake. During the first 12 days of life, preterm infant neurobehavioral outcomes were vulnerable to the negative impact of acute and chronic pain/stress. Future research is warranted to investigate the long-term effects of early-life pain/stress on neurobehavioral outcomes. Gestational age remains one of the critical factors to predict neurobehavioral outcomes in preterm infants; older gestational age significantly predicted better neurobehavioral outcomes. Feeding with a higher proportion of maternal breastmilk predicted better neurobehavioral outcomes. Future research is warranted to investigate how maternal breastmilk may buffer the negative effects of early-life pain/stress on neurobehavioral outcomes.

Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants

Introduction: Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. Methods: In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses. Results: We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. Conclusion: NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.

Measurement of Cumulative Preterm Neonatal and Maternal Stressors During Neonatal Intensive Care Unit Admission.

By nature, the neonatal intensive care unit (NICU) environment is stressful for both infants and mothers. This study aimed to explore and quantify the severity of early life stressors in premature infants admitted to the NICU and evaluate the effect of cumulative neonatal stressors on maternal mental health. This cross-sectional study included 100 preterm infants admitted to the NICU for at least 10 days. Daily experiences with painful/stressful procedures for 10 days were determined using the Neonatal Infant Stressor Scale. The included mothers were assessed for their psychological well-being 1 week after NICU admission using the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale. During the first 10 days of NICU admission, preterm infants experienced an average of 350.76 ± 84.43 acute procedures and an average of 44.84 ± 11.12 cumulative hours of chronic events, with the highest scores recorded on first 3 days of admission. Although intravenous flushing for patency was the most frequent acute procedure, blood gas sampling was the most painful. Forty-five percent of the mothers showed significant depressive symptoms, with the maternal role alteration reported as the most stressful experience, especially for young and new mothers (p < .001). The cumulative stressors experienced by infants were significantly associated with elevated maternal perception of psychological maladjustment (p < .001). This study confirmed that the NICU environment is stressful for both infants and mothers, with the total cumulative stressors experienced by preemies in the NICU having an negative impact on maternal mental health.

Developmental Care Implementation on preterm neonates in Ain Shams University Pediatric Hospitals: An interventional study

Abstract Introduction Developmental care is an approach to individualize care of infants to maximize neurological development and reduce long term cognitive and behavioral problems which may result from the stressful experience in the neonatal intensive care units like neonatal exposure to loud noise, bright light, heel pricking, orogastric suction and endotracheal intubation. It includes minimizing exposure to noise, light, proper skin to skin contact or kangaroo care, proper positioning, applying clustering of care and non-nutritive suckling. Objectives To study developmental care implementation and its relation to time to achieve full feed, length of hospital stay, amount of feeding, incidence of IVH, NEC &amp; ROP, and consequently death in preterm neonates admitted to NICU. Patients and methods A Double arm randomized controlled clinical trial, care application, carried out on 60 preterms in the Neonatal Intensive Care Unit, Children's Hospital, Ain Shams university. Inclusion criteria of Developmental care group &amp; controls (conventional care group) was; gestational age 29-36 week, no major congenital anomalies, and no pharmacological analgesics nor sedation were received before enrollment in the study. N-PASS (neonatal pain agitation sedation scale) and NISS (neonatal infant stressor scale) scores were assessed in both groups before and after developmental care implementation on developmental care group and conventional care application in conventional care group. Results N-PASS &amp; NISS scores were decreased significantly with developmental care application, developmental care implementation resulted in a significant decrease in time to achieve full feed &amp; length of hospital stay, there was a tendency to a decrease in incidence &amp; grading of IVH, NEC &amp; ROP, and consequently death in developmental care group compared to conventional care group. Conclusion Application of developmental care measures to NICU admitted preterm babies minimizes neonatal pain, stress, helps reaching amount of full feeding in a shorter time, with an increase in neonatal weight gain &amp; a decrease in length of hospital stay.

Maternal Anxiety, Infant Stress, and the Role of Live-Performed Music Therapy during NICU Stay in The Netherlands.

Having an infant in the neonatal intensive care unit (NICU) elicits maternal anxiety, which may hamper parent−child bonding. We performed a prospective cohort study to describe anxiety in mothers of infants born before 30 weeks of gestation during NICU stay in The Netherlands, and investigated the influence of infant stress and gestational age. Second, we performed a randomized-controlled live-performed music therapy trial (LPMT trial) to investigate whether music therapy applied to the infant alleviated maternal anxiety. The relation between infant stress, gestational age, and maternal anxiety was measured in 45 mother−infant dyads, using the Neonatal Infant Stressor Scale and the State-Trait Anxiety Inventory (STAI). The effect of LPMT on anxiety was assessed in 21 mothers whose infants were assigned to either LPMT (n = 12) or waitlist (n = 9). Mothers completed the STAI before and after this period. Maternal anxiety decreased over time in all mothers, and was strongly related with infant stress (r = 0.706, p < 0.001), but not with gestational age. Anxiety scores decreased by 12% after LMPT, and increased by 1% after a waitlist period (p = 0.30). Our results indicate that LPMT in the weeks after birth may accelerate the reduction of maternal anxiety. Further research should focus on the effects on mother−child bonding.

Measures of Stress Exposure for Hospitalized Preterm Infants.

Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures. The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior. Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes. Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior. The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.

Clinical validation of the Neonatal Infant Stressor Scale with preterm infant salivary cortisol.

Background:Preterm infants face unique stress states in early life. Early-life stress has been associated with changes in cortisol reactivity and behavioral abnormalities later in childhood in non-preterm populations. The neonatal infant stressor scale (NISS) has been used to estimate infant stress in the neonatal intensive care unit (NICU), but has not been biomarker-validated. The relationship between NISS scores and salivary cortisol is unknown.Objective:To test the association between NISS scores and salivary cortisol in the NICU Hospital Exposures and Long-Term Health (NICU-HEALTH) preterm birth cohort.Methods:386 salivary cortisol specimens were collected from 125 NICU-HEALTH participants during the NICU hospitalization. NISS scores were calculated to represent the infant’s experience in the 6 hours prior to specimen collection. Adjusted mixed-effect regression models were used to assess the association between each NISS score and salivary cortisol.Results:Acute and total NISS scores were significantly associated with salivary cortisol level (p=0.002 and 0.05 respectively). The chronic NISS score was not associated with salivary cortisol levels. Caffeine treatment and postmenstrual age of the infant at time of exam were important covariates in all models.Conclusion:Acute and total NISS score are associated with salivary cortisol level in hospitalized moderately preterm infants.

Correlation of Preterm Infant Salivary Cortisol Levels with Scores on the Neonatal Infant Stressor Scale

Correlation of Preterm Infant Salivary Cortisol Levels with Scores on the Neonatal Infant Stressor Scale

Temperament moderated by neonatal factors predicted behavioral problems in childhood: A prospective longitudinal study

ObjectiveThe present study aimed to examine the predictor effects of neonatal, sociodemographic characteristics, and temperament assessed at 18–36 months of age on behavioral problems in 4- to 5-year-old children born preterm. MethodsThe sample comprised 70 children born preterm. The amount and the intensity of stress procedures during a stay in the neonatal intensive care unit were evaluated using the Neonatal Infant Stressor Scale. Temperament was assessed using the Early Childhood Behavior Questionnaire, and behavioral problems were assessed using the Child Behavior Checklist 11/2–5. Multiple linear regression analysis was performed. ResultsTotal behavioral problems were predicted by a child temperament of more negative affectivity and less effortful control, moderated by gestational age. Internalizing behavioral problems was predicted by more negative affectivity and less effortful control moderated by male sex and associated with lower gestational age. Externalizing behavior problems was predicted by less effortful control. ConclusionsThe main findings of the present study showed that the high immaturity at the birth of preterm infants, associated with temperament traits of more negative affectivity and less effortful control, increase the risk for future behavioral problems.

Inflammatory mediators of stress exposure and neurodevelopment in very preterm infants: Protocol for the stress neuro-immune study.

(a) Determine relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants and determine the mediated effect of inflammation on the relationship between stress exposure and neurodevelopment; (b) describe cytokine trajectories following birth and determine the effect of stress exposure on these trajectories; and (c) examine relationships between stress exposure and chronic stress responses in very preterm infants. Non-experimental, repeated measures. Very preterm infants born 28-31weeks post menstrual age will be enrolled. Cumulative stress exposure over the first 14days of life will be measured using the Neonatal Infant Stressor Scale. Blood will be collected weekly for the quantification of cytokines. Neurodevelopment will be assessed using the Neurobehavioral Assessment of the Preterm Infant and hair for quantification of hair cortisol will be collected at 35weeks post menstrual age. Multiple linear regression and conditional process analysis will be used to analyse the relationships among stress exposure, inflammation and neurodevelopment. Linear mixed models will be used to determine inflammatory trajectories over time. IRB approval for the study was received May 2017, and funding from the National Institute of Nursing Research was awarded July 2017. This study will determine the extent to which inflammation mediates the relationship between stress exposure and neurodevelopment. Interventions to attenuate inflammation in preterm infants may improve outcomes. Determining the potentially modifiable mediators of stress exposure and neurodevelopment in preterm infants is critical to improving long-term outcomes.

Novel method of measuring chronic stress for preterm infants: Skin cortisol

Background and objectivesInfants who begin life in the medicalized environment of the neonatal intensive care unit (NICU) do so under stressful conditions. Environmental exposures are often abrasive to vulnerable infants, while invasive and noninvasive lifesaving interventions provide additional pain and/or stress. The most commonly selected biomarker to measure stress is cortisol. The skin is the barrier between the external environment and communicates with our neurological, endocrine and immune regulatory networks. To examine if skin cortisol may be a reliable biomarker of stress, NICU stress exposure and repeated measurements of skin cortisol in very preterm infants were examined retrospectively during the first 6 weeks of life. The temporal relationship between skin cortisol and NICU stress exposure was also analyzed. Materials and methodsParticipants included 82 preterm infants born weighing less than 1500 g, admitted to a level III NICU, with a mean gestational age of 28.5 weeks. Infants were studied from birth through 6 weeks of life. NICU stress data was collected using the Neonatal Infant Stressor Scale. Skin samples were collected using d-squame tape as soon after birth as possible and every two weeks thereafter. ResultsOn average, infants experienced approximately 43 stressful events per day during the first 6 weeks of life in the NICU. Stress level and cortisol reactivity varied by gestation age. Higher stress resulted in higher cortisol for infant >28 weeks; lower stress scores were associated with higher stress for infants <28 weeks. Stress exposure during 7 days prior to cortisol sampling yielded the highest AUC for the 2 groups. A statistically significant interaction was identified between gestational age and stress exposure during the previous 7 days (p < 0.01). ConclusionThis is the first study to demonstrate skin cortisol as a preterm infant biomarker of chronic stress exposure. For infants with appropriate skin maturation, this non-invasive sampling method provides several benefits. Importantly, this method may be less intrusive and disruptive for preterm infants.

Effects of Neonatal Pain and Temperament on Attention Problems in Toddlers Born Preterm.

To examine the effects of individual characteristics of neonates and neonatal pain-related stress on attention problems and externalizing behavior problems of toddlers born preterm, analyzing the moderating effects of the dispositional traits of temperament. The sample included 62 toddlers aged 18-36 months and their mothers. The mothers were interviewed using the Child Behavior Checklist 1.5-5 for toddlers' attention and externalizing behavior problems assessment, the Early Childhood Behavior Questionnaire for toddlers' temperament assessment, and the Adult Temperament Questionnaire for their temperament assessment. The Neonatal Infant Stressor Scale analyzed the number of pain-related stress events during neonatal intensive care unit (NICU) hospitalization recorded in the medical charts. Statistical descriptive, correlation, and multiple linear regression analyses were performed. High neonatal pain-related stress total index, associated with toddler's temperament with less Effortful Control, and mother's temperament with high Surgency explained 23% variability of the attention problems. Otherwise, the externalizing behavior problems were explained by temperament, but not by neonatal pain-related stress. The findings support the impact of neonatal pain experiences, and current toddlers' and mothers' temperament characterized by poorer self-regulation on attention problems in toddlers born preterm. Developmental care in the NICU and follow-up programs after discharge are recommended to promote regulated temperament of the mother-child dyads, aiming to prevent attentional problems in toddlers born preterm.

Cumulative pain-related stress and developmental outcomes among low-risk preterm infants at one year corrected age

BackgroundExtensive exposure of preterm infants to pain-related stress (PRS) at a time of physiological immaturity and rapid brain development may contribute to altered neurodevelopment. ObjectiveTo examine the relationship between early PRS and neurodevelopmental outcomes among low-risk very preterm infants at the age of one year corrected age (CA). MethodsParticipants included 107 infants born <32weeks gestational age (GA) and monitored prospectively at 12.5months CA. Excluded were infants with severe neonatal morbidities associated with impaired neurodevelopment. PRS documentation was performed via the number of skin-breaking procedures (SBP) and by the use of the neonatal infant stressor scale (NISS). Adjustment was made for early neonatal morbidities. ResultsDevelopmental outcomes among the study infants were within the norm (mean 100±11.03). Infants who underwent invasive mechanical ventilation (IMV) (n=31) were exposed to significantly more PRS than non-IMV infants (n=76) (p<0.000). Developmental outcomes were similar in both groups (99.7±11.1 vs. 100.8±11 p=0.63). Among IMV infants, increased exposure to PRS was associated with lower developmental scores independent of GA, gender or other sociodemographic factors. ConclusionIncreased exposure to PRS among low-risk preterm infants who underwent IMV is associated with lower developmental scores at 12.5month CA.

Cumulative Stressors in Preterm Infants Hospitalized in Neonatal Intensive Care Units

Background: Infants’ exposure to stressors in neonatal intensive care unit (NICU) and its outcomes is a new issue since previous studies have only focused on painful stimuli. Taking into account frequency and severity of the stressors on each infant, short and long-term outcome of these stressors can be improved. Objectives: This study aimed to evaluate the cumulative stressors in premature infants hospitalized in a NICU. Methods: In this descriptive study, 197 hospitalized preterm infants between 28 to 30 weeks of gestation were studied in terms of cumulative stressors during 10 days at the NICU of Tabriz Alzahra hospital. Consecutive sampling method was used. Demographic questionnaire and neonatal infant stressor scale were used. Descriptive statistics, repeated measures analysis and Pearson’s correlation coefficient tests were used to analyze the data. Results: The total mean of stress scores during 10 days was 99.44 ± 17.37. “Multiple attempts to insert intravenous and intra-arterial catheters and “intubation” were the most frequent procedures in the “extremely stressful” category among four categories of stressors. The highest scores of acute and chronic stress were related to the tenth and third day of hospitalization, respectively. There was no significant difference between infants’ characteristics and total mean stress scores. Repeated measures analysis showed that the mean acute stress scores were significantly different among the 10 subsequent days (P < 0.05). Conclusions: The results of this study demonstrated the frequent occurrence of various procedures in preterm infants hospitalized at the NICU. Although these procedures were done with the purpose of improving infants’ health, they can lead to problems and complications, which might postpone the infants’ recovery process.