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Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants
Nienke H van Dokkum1,2, Marlou L A de Kroon2, Peter H Dijk1
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Insights
Neonatal Infant Stressor Scale (NISS) scores were highest in the first week of life for preterm infants. Stress levels declined over 28 days, influenced by gestational age and clinical factors.
Area of Science:
- Neonatalogy
- Pediatric Intensive Care
- Infant Stress Research
Background:
- Understanding neonatal stress is crucial for developing targeted interventions in the Neonatal Intensive Care Unit (NICU).
- Preterm infants experience significant stress during their NICU stay, impacting their development and well-being.
Purpose of the Study:
- To describe the course of stress in preterm infants during the first 28 days of life.
- To investigate the influence of gestational age on stress levels.
- To identify associations between stress and clinical characteristics in preterm infants.
Main Methods:
- A prospective cohort study including preterm infants with gestational age <30 weeks or birth weight <1,000 g.
- Daily stress was measured using the Neonatal Infant Stressor Scale (NISS) over 28 days.
- Regression analyses assessed the association of cumulative NISS scores with clinical factors.
Main Results:
- 45 preterm infants (median gestational age 27 weeks) were included.
- Mean daily NISS scores were highest in the first week and decreased over 28 days.
- Lower gestational age was associated with slower decline in NISS scores, particularly nursing-related stress.
Conclusions:
- Neonatal stress, measured by NISS, is highest in the first week and declines over 28 days.
- The trajectory of stress reduction is dependent on gestational age at birth.
- Clinical factors like sepsis and intraventricular hemorrhage are associated with higher cumulative stress scores.
Introduction:
Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics.
Methods:
In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses.
Results:
We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days.
Conclusion:
NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.
