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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Stress assessment instruments for hospitalized preterm newborns: scoping review
Mónica Costa1, Maria Filomena Gaspar2, Maria Alice Curado2
1Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Saúde do Instituto Politécnico de Setúbal, Lisboa, Portugal. mcrcosta81@gmail.com.
Insights
Assessing stress in preterm newborns is crucial. This review found limited tools specifically for neonatal stress, highlighting the need for better instruments to ensure neuroprotective care and improve infant well-being.
Area of Science:
- Neonatal care
- Pediatric intensive care
- Developmental psychology
Background:
- Neonatal intensive care units (NICUs) present a technologically advanced yet potentially traumatic environment for newborns.
- Preterm infants are particularly vulnerable to the effects of early and frequent exposure to multiple stressors.
- Systematic observation and assessment of newborn behavior are vital for interpreting stress signals and planning interventions.
Purpose of the Study:
- To identify and map existing instruments for assessing stress in preterm newborns within neonatal units.
- To evaluate the current evidence base for stress assessment tools in this population.
Main Methods:
- A scoping review was conducted using Joanna Briggs Institute (JBI) methodology and the PRISMA ScR model.
- Research involved searching Medline, CINALH, Scielo, and PubMed databases.
- Two independent reviewers screened citations, abstracts, and full-text articles.
Main Results:
- Ten primary studies were included in the review.
- Seven distinct scales were identified for assessing stress and/or pain in newborns.
- Most tools assess pain and stress concurrently, with some limitations in capturing individualized stress responses.
Conclusions:
- There is a limited availability of instruments exclusively designed for assessing neonatal stress.
- Differentiating stress from pain is critical for implementing targeted, neuroprotective interventions.
- Developing and validating stress-specific tools, alongside adapting NICU environments, is essential for promoting infant well-being and long-term development.
Background:
The highly technological environment existing in intensive care units, essential for the survival of the newborn, contributes with a potentially devastating and traumatic effect, especially in preterm newborns and in their future lives, due to the early and frequent exposure to multiple stressors. The preterm newborn must be observed in a systematic and structured way, before, during and after any intervention, aiming at the correct assessment and interpretation of his behaviour and signs of stress, and at the timely planning of interventions that minimize and prevent stress. The objective of this review is to identify and map the instruments for assessing stress in preterm newborns admitted to neonatal units in scientific evidence.
Methods:
A scoping review was carried out using the methodology presented by The Joanna Briggs Institute (JBI) and the PRISMA ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews) for structuring the collected information. The research was carried out in three distinct phases supported by the Medline, CINALH databases through the EBSCO, Scielo and PubMed platform. Two reviewers screened all citations, abstract data and full-text articles, independently.
Results:
Ten articles were selected, all primary studies. Seven different scales were identified in the studies.
Discussion:
This review highlights the limited availability of instruments exclusively designed to assess neonatal stress in neonatology. While most tools, like the Newborn Comfort Behavior Scale and ALPS-Neo, focus on pain and stress together, the NISS and NSS provide valuable insights despite limitations in capturing individualized stress responses. Differentiating stress from pain is crucial for implementing targeted, neuroprotective interventions. Adapting neonatology environments and care practices to minimize stressors is essential for promoting newborns' well-being and long-term development.
Conclusion:
The findings underscore the critical need for stress-specific assessment tools in NICUs to differentiate between pain and stress. Existing instruments offer valuable insights but have notable limitations. Expanding validated tools and prioritizing individualized, neuroprotective care are essential for improving outcomes. Adapting neonatology practices to reduce stressors and implement family-centered care will support the holistic needs of newborns, fostering their development, physiological stability, and overall well-being.
System Review Registration:
Open Science Framework ( https://osf.io/nsu95/ ).
