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

• Published in: Early human development Vol. 108; pp. 9 - 16
• Main Authors: Cong, Xiaomei, Wu, Jing, Vittner, Dorothy, Xu, Wanli, Hussain, Naveed, Galvin, Shari, Fitzsimons, Megan, McGrath, Jacqueline M., Henderson, Wendy A.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2017
• Subjects: Advanced Basic Science; Child Development; Developmental Disabilities - epidemiology; Female; Humans; Infant, Newborn; Infant, Premature - growth & development; Intensive Care Units, Neonatal - statistics & numerical data; Male; Neonatal and Perinatal Medicine; Neonatal intensive care; Neurobehavioral outcomes; Pain; Pain - epidemiology; Preterm infants; Stress; Stress, Psychological - epidemiology; Neonatal intensive care; Pain; Neurobehavioral outcomes; Stress; Preterm infants
• ISSN: 0378-3782; 1872-6232; 1872-6232
• DOI: 10.1016/j.earlhumdev.2017.03.003

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. 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. 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). 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. •Preterm infants experienced a high degree of pain/stress in the NICU, both in acute events and chronic/stressful exposures.•Both acute and chronic pain/stress experienced in early life significantly contributed to the neurobehavioral outcomes.•Systematic monitoring of pain/stressor and providing early neuroprotective interventions for high-risk infants are needed.