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Updated: May 9, 2026
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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A Concept Analysis of NICU-Based Toxic Stress
Hind B Alsabti1, Susan M Ludington-Hoe
1Author Affiliations: Frances Bolton Payne School of Nursing, CWRU, Cleveland Ohio (Mrs Alsabti); School of Nursing, King Saud University, Riyadh, Saudi Arabia (Mrs Alsabti); and Frances Bolton Payne School of Nursing, CWRU, Cleveland Ohio (Dr Ludington-Hoe).
Summary
Toxic stress in premature infants (PTIs) is poorly defined in neonatal intensive care units (NICUs). This study clarifies toxic stress, emphasizing the need for better assessment and interventions to support infant neurodevelopment.
Area of Science:
- Neonatal intensive care
- Pediatric neurodevelopment
- Child psychology
Background:
- Neonatal intensive care units (NICUs) expose preterm infants (PTIs) to significant stressors.
- The concept of toxic stress is not well-defined for infants, particularly in the NICU setting.
- Lack of supportive care can lead to adverse childhood experiences and negative neurodevelopmental outcomes.
Purpose of the Study:
- To clarify the concept of toxic stress in premature infants and children under two years old.
- To define the attributes, antecedents, and consequences of toxic stress in this population.
Main Methods:
- Utilized Walker and Avant's Wilsonian concept analysis method.
- Searched databases (PubMed, CINAHL, Google Scholar) using keywords related to toxic stress.
- Analyzed 33 English articles published within the last 20 years.
Main Results:
- Developed an enhanced definition and empirical referents for toxic stress in infants.
- Identified defining attributes, antecedents, consequences, and exemplar cases of toxic stress.
- Highlighted the underutilization of the toxic stress concept in NICU care.
Conclusions:
- Clinical practice lacks consistent assessment of physiologic and behavioral toxic stress in NICU infants.
- Further research is needed to develop and test interventions for minimizing toxic stress.
- High-quality nursing assessment and family-integrated care are crucial for mitigating toxic stress impacts.
Keywords:
NICU/neonatal intensive care unitadverse early infancy experiencesadversitybehavioral stress responsebufferingneonate/preterm infantphysiologic stress responsesregulationseparationstresstoxic stresstoxic stress epigeneticsMore Related Videos
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