A Concept Analysis of NICU-Based Toxic Stress

Preterm infants (PTIs) are exposed to tremendous stressors within the neonatal intensive care unit (NICU), an environment that is supposed to be nurturing rather than disruptive. Toxic stress has yet to be defined as a concept relevant to premature and older infants. The lack of buffering support (a mother or another meaningful adult who provides physical/emotional support to minimize stressful events and promote resilience) triggers adverse childhood experiences leading to unfavorable-neurodevelopmental consequences.

This article aims to clarify the concept of toxic stress in premature infants and infants younger than 2 years old.

Walker and Avant's approach is the Wilsonian method, which is a systematic approach for clarifying and presenting a concept. The analysis focuses on infants aged 0 to 24 months in the NICU setting. Using the keywords related to toxic stress' physiologic and behavioral responses, databases including PubMed, CINAHL, and Google Scholar were searched to explore the toxic stress concept.

Analysis of 33 English articles published in the last 20 years yielded an enhanced definition and empirical referents of toxic stress. The defining attributes, antecedents, consequences, and exemplar cases of the proposed concept were discussed.

Clinical concerns are the uncommon use of the toxic stress concept in the NICU and the lack of physiologic and behavioral toxic stress assessment during routine care. Interventional studies are needed to test strategies to minimize/eliminate toxic stress and modify NICU practices. Mitigating the negative impacts of toxic stress often relies on high-quality nursing assessment and family-integrated care models incorporation.