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Neonatal Stress, Health, and Development in Preterms: A Systematic Review
Nienke H van Dokkum1,2, Marlou L A de Kroon2, Sijmen A Reijneveld2
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital n.h.van.dokkum@umcg.nl.
Insights
Neonatal stress negatively impacts preterm infants
Area of Science:
- Neonatology
- Developmental Pediatrics
- Perinatal Medicine
Background:
- Neonatal intensive care unit (NICU) stays involve numerous stressors for preterm infants.
- Understanding the impact of these stressors on infant health and development is crucial for improving care.
Purpose of the Study:
- To systematically review the literature on associations between neonatal stressors and the health and development of preterm infants.
Main Methods:
- Comprehensive database search (Embase, Medline, PsycINFO, CINAHL) and reference list review.
- Inclusion of observational studies measuring neonatal stress and reporting clinical, laboratory, or imaging outcomes in preterm infants.
- Data extraction and quality assessment by two independent reviewers.
Main Results:
- Twenty articles revealed negative associations between neonatal stress and cognitive, motor, and emotional development.
- Stress was linked to epigenetic alterations, hypothalamic-pituitary-adrenal axis dysfunction, and altered brain development.
- No evidence was found linking stress to growth, cardiovascular health, parent-infant interaction, or the neonatal immune system/microbiome.
Conclusions:
- Neonatal stress significantly affects preterm infant health and development.
- Physicians must recognize and address neonatal stress in clinical practice and follow-up care.
Context:
An overview of the full range of neonatal stressors and the associated clinical, laboratory, and imaging outcomes regarding infants' health and development may contribute to the improvement of neonatal care.
Objective:
To systematically review existing literature on the associations between all kinds of neonatal stressors and the health and development of preterm infants.
Data Sources:
Data sources included Embase, Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and reference lists.
Study Selection:
Studies were eligible if they included a measure of neonatal stress during the NICU stay, reported clinical, laboratory, and/or imaging outcomes regarding health and/or development on discharge from the NICU or thereafter, included preterm infants, and were written in English or Dutch.
Data Extraction:
Two reviewers independently screened the sources and extracted data on health and development. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment Scale.
Results:
We identified 20 articles that reported on neonatal stress associated negatively with clinical outcomes, including cognitive, motor, and emotional development, and laboratory and imaging outcomes, including epigenetic alterations, hypothalamic-pituitary-adrenal axis functioning, and structural brain development. We found no evidence regarding associations with growth, cardiovascular health, parent-infant interaction, the neonatal immune system, and the neonatal microbiome.
Limitations:
The studies were all observational and used different definitions of neonatal stress.
Conclusions:
Neonatal stress has a profound impact on the health and development of preterm infants, and physicians involved in their treatment and follow-up should be aware of this fact.
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