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Association between exposure to stress and experienced discomfort in preterm infants

Erik Koning1, Arend F Bos2, Elisabeth M W Kooi2

  • 1Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands. e.koning@umcg.nl.

Pediatric Research
|May 22, 2026
PubMed

Insights

Cumulative stress exposure in the NICU does not predict discomfort in preterm infants. Postnatal age is a key factor, with higher discomfort scores noted on days 3 and 5.

Area of Science:

  • Neonatal intensive care
  • Perinatal medicine
  • Pediatric pain and stress

Background:

  • Extremely and very preterm infants face significant stressors in the NICU.
  • Understanding factors influencing infant discomfort is crucial for optimizing care.

Purpose of the Study:

  • To investigate the relationship between cumulative stress exposure and infant discomfort.
  • To determine if gestational age, postnatal age, or medication use affects discomfort in the first week of life.

Main Methods:

  • Retrospective study of 82 preterm infants (41 extremely, 41 very preterm).
  • Assessed stress using the Neonatal Infant Stressor Scale (NISS).
  • Measured discomfort with the COMFORTneo scale, adjusting for clinical factors.

Main Results:

  • Cumulative stress exposure (NISS) did not correlate with discomfort scores.
  • Gestational age and sedative/analgesic use were not significant predictors.
  • Discomfort scores (COMFORTneo) were highest on postnatal days 3 and 5.

Conclusions:

  • NICU stress exposure does not directly predict discomfort in preterm infants.
  • Postnatal age is a significant factor influencing discomfort levels.
  • Discomfort assessment in preterm infants is complex and influenced by multiple factors beyond direct stress.
Abstract

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