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Early Hum Dev. 2017 May;108:9-16. doi: 10.1016/j.earlhumdev.2017.03.003. Epub 2017 Mar 23.

The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU.

Author information

1
School of Nursing, University of Connecticut, Storrs, CT, United States; Institute for Systems Genomics, University of Connecticut, Farmington, CT, United States; School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, United States. Electronic address: xiaomei.cong@uconn.edu.
2
Department of Statistics, University of Connecticut, Storrs, CT, United States.
3
School of Nursing, University of Connecticut, Storrs, CT, United States; Connecticut Department of Developmental Services, Hartford, CT, United States.
4
School of Nursing, University of Connecticut, Storrs, CT, United States.
5
School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, United States; Connecticut Children's Medical Center, Hartford, CT, United States.
6
Connecticut Children's Medical Center, Hartford, CT, United States.
7
School of Nursing, University of Connecticut, Storrs, CT, United States; Connecticut Children's Medical Center, Hartford, CT, United States.
8
Digestive Disorders Unit, Biobehavioral Branch, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States.

Abstract

BACKGROUND:

Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU.

METHODS:

A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes.

RESULTS:

Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97±2.30 procedures) and cumulative times of chronic/stressful exposure (42.59±15.02h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p<0.05) and habituation responses (p<0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p<0.01-0.05).

CONCLUSION:

Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes.

KEYWORDS:

Neonatal intensive care; Neurobehavioral outcomes; Pain; Preterm infants; Stress

PMID:
28343092
PMCID:
PMC5444300
DOI:
10.1016/j.earlhumdev.2017.03.003
[Indexed for MEDLINE]
Free PMC Article

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