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Published on: August 25, 2014
Measures of Stress Exposure for Hospitalized Preterm Infants
Marliese Dion Nist1, Tondi M Harrison, Rita H Pickler
1Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus.
Insights
Hospitalized preterm infants experience varied stress exposures. Current measures of stress exposure are highly correlated but do not predict early neurobehavioral outcomes in these vulnerable infants.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Developmental Pediatrics
- Infant Neurobehavioral Assessment
Background:
- Extended hospitalization in NICUs exposes preterm infants to significant stress.
- This stress can negatively impact long-term cognitive function, motor development, and stress reactivity.
- Measuring cumulative stress exposure in neonates is complex, with various methods employed.
Purpose of the Study:
- To compare commonly used measures of stress exposure in preterm infants.
- To determine the predictive validity of these stress measures for early neurobehavioral development.
- To describe stress exposures during the first two weeks of life for very preterm infants.
Main Methods:
- Seventy-one very preterm infants (28-31 weeks postmenstrual age) were studied.
- Stress exposure was quantified via skin-breaking procedures, invasive procedures, and the Neonatal Infant Stressor Scale.
- Neurobehavior was assessed at 35 weeks postmenstrual age using specific subscales of the Neurobehavioral Assessment of the Preterm Infant.
Main Results:
- Significant individual variability was observed in all stress exposure measures.
- Measures of stress exposure demonstrated moderate to high correlations with each other.
- None of the assessed stress exposure measures were significantly associated with early neurobehavioral outcomes.
Conclusions:
- While stress exposure measures are correlated, their association with early neurobehavior is lacking.
- Current stress measurement tools may not accurately reflect physiological stress responses in preterm infants.
- Further research is needed to develop more accurate and predictive measures of neonatal stress exposure.
Background:
Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures.
Objectives:
The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior.
Methods:
Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes.
Results:
Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior.
Discussion:
The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.
