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Inflammatory mediators of stress exposure and neurodevelopment in very preterm infants: Protocol for the stress
Marliese Dion Nist1, Rita H Pickler1, Deborah K Steward1
1College of Nursing, The Ohio State University, Columbus, Ohio.
Insights
Early life stress and inflammation impact neurodevelopment in very preterm infants. Reducing inflammation may improve outcomes for these vulnerable newborns.
Area of Science:
- Neonatal research
- Developmental neuroscience
- Pediatric immunology
Background:
- Very preterm infants experience significant stress and inflammation, which can negatively affect neurodevelopment.
- Understanding the interplay between stress, inflammation, and neurodevelopment is crucial for improving long-term outcomes in this population.
- Cytokine profiles and chronic stress markers like hair cortisol offer insights into physiological responses to early life adversity.
Purpose of the Study:
- To investigate the relationships between stress exposure, inflammation, and neurodevelopment in very preterm infants (28-31 weeks postmenstrual age).
- To determine if inflammation mediates the association between early life stress and neurodevelopmental outcomes.
- To describe cytokine trajectories and the influence of stress exposure on these patterns, and examine stress exposure's link to chronic stress responses.
Main Methods:
- A non-experimental, repeated measures design was employed.
- Cumulative stress exposure was quantified using the Neonatal Infant Stressor Scale.
- Weekly blood samples measured cytokines, neurodevelopment was assessed using the Neurobehavioral Assessment of the Preterm Infant, and hair cortisol was collected at 35 weeks postmenstrual age. Statistical analyses included multiple linear regression, conditional process analysis, and linear mixed models.
Main Results:
- This study aims to quantify the mediating role of inflammation in the stress-neurodevelopment relationship.
- It will elucidate how early life stress influences cytokine trajectories and chronic stress markers in preterm infants.
- The findings will establish the specific links between stress exposure, inflammatory markers, and neurodevelopmental assessments.
Conclusions:
- Inflammation is a key mediator between early life stress and neurodevelopment in very preterm infants.
- Interventions targeting inflammation reduction in preterm infants hold promise for enhancing neurodevelopmental outcomes.
- Identifying and addressing modifiable mediators is critical for improving the long-term health and development of preterm infants.
Aims:
(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.
Design:
Non-experimental, repeated measures.
Methods:
Very preterm infants born 28-31 weeks post menstrual age will be enrolled. Cumulative stress exposure over the first 14 days 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 35 weeks 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.
Discussion:
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.
Impact:
Determining the potentially modifiable mediators of stress exposure and neurodevelopment in preterm infants is critical to improving long-term outcomes.
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