Measuring preterm cumulative stressors within the NICU: The neonatal infant stressor scale

• Published in: Early human development Vol. 85; no. 9; pp. 549 - 555
• Main Authors: Newnham, C.A., Inder, T.E., Milgrom, J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.09.2009; Elsevier
• Subjects: Advanced Basic Science; Biological and medical sciences; Child development; Embryology: invertebrates and vertebrates. Teratology; Female; Fundamental and applied biological sciences. Psychology; Humans; Infant Welfare; Infant, Newborn; Infant, Premature - physiology; Infant, Premature - psychology; Intensive Care Units, Neonatal; Male; Medical care research; Neonatal and Perinatal Medicine; Neonatal Intensive Care Unit; Preterm birth; Stress; Stress, Physiological; UVC; CPAP; Preterm birth; ETT; MRI; ECG; ICC; NICU; Neonatal Intensive Care Unit; IV; Stress; PCA; HFO; CT; Child development; Medical care research; UAC; IA; GA; NGT; SCN; postconceptional age; magnetic resonance imaging; umbilical venous catheter; CAT scan; endotracheal tube; Special Care Unit; gestational age; intravenous (line); nasogastric tube; pneumothorax chest drain; intra-arterial line; continuous positive airway pressure; echocardiogram; high flow oxygen; umbilical arterial catheter; Human; Premature; Neonatal; Pregnancy disorders; Premature delivery; Infant; Care; Intensive care unit; Prematurity; Development; Child
• ISSN: 0378-3782; 1872-6232; 1872-6232
• DOI: 10.1016/j.earlhumdev.2009.05.002

Stress experiences, while pervasive, are less likely than painful experiences to be managed in still-hospitalised preterm infants. We aimed to quantify the severity of common stressors for preterm infants with a view to providing a tool to manage presumed accumulated infant stress. Seventeen doctors and 130 nurses who work in Neonatal Intensive and Special Care Nurseries rated the perceived stress severity of 44 acute events and 24 chronic living conditions for preterm infants at three ages (< 28 weeks, 28–32 weeks, > 32 weeks post-conceptional age) and for themselves. Acute items (such as heel lance) were organised into nursing, peripheral venous access, peripheral arterial access, central vascular access, ventilation, nutrition, medical procedures, surgery, radiology and miscellaneous categories. Chronic living conditions included items such as receiving intranasal oxygen and having a systemic infection. Doctors and nurses perceived nearly all items to be stressful to infants to some degree and to be equally stressful across ages. The degree of stress experienced by clinicians themselves was generally low and moderately correlated with presumed infant stress for the same items. Presumed infant stress was inversely related to clinician age. Based on these results we developed the Neonatal Infant Stressor Scale to help track, measure and manage presumed accumulated stress in preterm neonates.