Understanding infant stress in neonatal and pediatric intensive care: a scoping review

Infants in intensive care environments encounter numerous stressors which may overlap or occur in close proximity. Recent literature suggests stressful encounters in the neonatal or early infant period are harmful to physiological, functional, and structural systems, both acutely and longitudinally. Identifying these stressors and assessing the stress burden in this vulnerable population is crucial for developing care models that minimize unnecessary stress, thereby enhancing recovery and survival. This scoping review identified sources of stress encountered by infants hospitalized in intensive care environments, as reported in empiric literature. A total of 51 studies met eligibility criteria. Identified stressors were categorized into environmental stressors, stressors associated with routine care, and stressors associated with noxious or painful procedures. Studies predominately focused on premature infants in neonatal intensive care units; research on stressors in general pediatric intensive care units or among infants with congenital heart disease or other congenital anomalies is lacking. Evaluation of infant stress varied across studies, though most utilized vital sign alterations, biochemical markers, biophysical assessment, or observational scales by clinician report. Across studies, findings suggest stress experienced by infants in intensive care settings may contribute to physiological disruptions and developmental vulnerabilities.