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Updated: Jul 13, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Extremity movements help occupational therapists identify stress responses in preterm infants in the neonatal
1Centre for Community Child Health Research, Child and Family Research Institute, Children's and Women's Health Centre of British Columbia, Canada. lholsti@cw.bc.ca
Insights
Specific extremity movements in preterm infants can indicate pain and stress during neonatal intensive care unit procedures. This research identifies key movements for developing better clinical stress assessments.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Pain and stress research
Background:
- Pain and stress in preterm infants require accurate assessment and treatment.
- Adverse responses can lead to long-term developmental changes.
- Neonatal intensive care units (NICU) present unique challenges for infant well-being.
Purpose of the Study:
- To systematically review evidence on specific extremity movements in preterm infants.
- To observe infant responses during stressful neonatal procedures.
- To identify reliable indicators of pain and stress.
Main Methods:
- Conducted a comprehensive search of five online databases.
- Included 18 identified studies, with seven comprising the final review.
- Analyzed 359 preterm infants, calculating effect sizes and assessing study validity.
Main Results:
- Identified six specific extremity movements associated with painful procedures.
- Found these movements to be reliable biobehavioral indicators.
- Established a foundation for objective pain and stress measurement.
Conclusions:
- Specific infant extremity movements can serve as markers for pain and stress.
- These movements, combined with other measures, can inform clinical stress scale development.
- Future research can refine objective assessment tools for preterm infants.
Background:
Accurate assessment and treatment of pain and stress in preterm infants in neonatal intensive care units (NICU) is vital because pain and stress responses have been linked to long-term alterations in development in this population.
Purpose:
To review the evidence of specific extremity movements in preterm infants as observed during stressful procedures.
Methods:
Five on-line databases were searched for relevant studies. For each study, levels of evidence were determined and effect size estimates were calculated. Each study was also evaluated for specific factors that presented potential threats to its validity.
Results:
Eighteen studies were identified and seven comprised the review. The combined sample included 359 preterm infants. Six specific movements were associated with painful and intrusive procedures.
Clinical Implications:
A set of specific extremity movements, when combined with other reliable biobehavioural measures of pain and stress, can form the basis for future research and development of a clinical stress scale for preterm infants.
