Search

Background: Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures. Objectives: The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior. Methods: Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes. Results: Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior. Discussion: The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This pilot study explored how maternal stress experienced in the neonatal intensive care unit (NICU) is affected by the individual nursing structure and the network that provides care to extremely preterm infants. Background: Mothers experience high stress when their extremely preterm infants are hospitalized in the NICU. This often translates into maladaptive parenting behaviours that negatively affect the long‐term cognitive, social, and emotional development of the infant. Efforts to identify modifiable sources of maternal stress in the NICU could lead to improvement in maternal engagement and, ultimately, long‐term neurodevelopmental outcomes. Method: Time‐ and date‐stamped nursing shift data were extracted from the medical record and transformed into five structural nursing metrics with resultant nurse data networks. These were then analysed for associations with maternal stress outcomes on the Parental Stressor Scale (PSS: NICU). Results: Infants experienced highly variable nursing care and networks of nurses throughout their hospitalization. This variability is associated with the PSS: NICU (a) Sights and Sounds and (b) Altered Parental Role subscales. Conclusion: Nursing structure and the resultant caregiving network have an impact on maternal stress. Implications for Nursing Management: Changing the pattern of nurse staffing may be a modifiable intervention target for reducing maternal stress in the NICU. [ABSTRACT FROM AUTHOR]

The biological embedding of early life stress exposure may result in life‐long neurodevelopmental impairment in preterm infants. Infants hospitalized in the neonatal intensive care unit are exposed to significant experiential, environmental, and physiologic stressors over the course of their extended hospitalization. Stress exposure during the sensitive period of brain development may alter biological processes, including functioning of the immune system, the autonomic nervous system, and the hypothalamic‐pituitary‐adrenal axis as well as gene expression. These alterations may subsequently affect brain structure and function. Changes to these processes may mediate the relationship between neonatal stress exposure and neurodevelopment in preterm infants and represent potential therapeutic targets to improve long‐term outcomes. The purpose of this paper is to introduce a conceptual model, based on published research, that describes the mechanisms mediating stress exposure and neurodevelopment impairment in preterm infants and to provide the theoretical foundation on which to base future descriptive research, intervention studies, and clinical care. [ABSTRACT FROM AUTHOR]

Extremely premature infants, born 28 weeks gestation or less, are at high risk for impaired socioemotional development, due in part to exposure to early stressful social experiences that alter brain development. Understanding mediators that link experience with outcomes is necessary to assess premature infant responses to social experiences that are critical to brain development. The hormone oxytocin (OT), released during supportive interactions, has potential as a biomarker of the premature infant's responses to social experiences. The purpose of this study was to examine associations among infant plasma OT trajectories and maternal-infant social engagement behaviors during initial hospitalization. This study also examined demographic correlates of engagement behaviors in mothers and infants. Plasma from 28 extremely premature infants, born gestational ages 25-28 6/7 weeks, was collected at 14 days of life, then weekly until 34 weeks. Social engagement behaviors were measured by the Parent-Child Early Relational Assessment during a videotaped feeding when the infant was receiving one-quarter full oral feeds. Maternal-infant demographics were extracted from the medical record. Higher infant plasma OT was associated with lower infant social engagement, but no associations were found with maternal social engagement. Infant social engagement was positively related to maternal social engagement. Maternal parity was related to maternal social engagement, and infant demographics did not predict infant social engagement. The significant, yet negative, association between infant OT and engagement provides support for the measurement of OT as a neurobiological antecedent to infant social behaviors. Finally, this research suggests that during the earliest period of infant socio-behavioral development, premature infants are behaviorally reactive to the social engagement behaviors of their mothers. [ABSTRACT FROM AUTHOR]

Premature infants confront numerous physiologic and environmental stressors in the neonatal intensive care unit (NICU) that have the potential to permanently alter their neurodevelopment. Schore’s regulation theory postulates that positive maternal–infant interactions can shape the infant’s developmental outcomes through inducing mechanistic changes in brain structure and function. The purposes of this article are to explain the regulation of infant neurobiological processes during interactions between mothers and healthy infants in the context of Schore’s theory, to identify threats to these processes for premature infants, and to propose principles of clinical practice and areas of research necessary to establish a supportive environment and prevent or reduce maladaptive consequences for these vulnerable infants. A premature birth results in the disruption of neurodevelopment at a critical time. Chronic exposure to stressors related to the NICU environment overwhelms immature physiologic and stress systems, resulting in significant allostatic load, as measured by long-term neurodevelopmental impairments in the premature infant. Positive maternal–infant interactions during NICU hospitalization and beyond have the potential to reduce neurologic deficits and maximize positive neurodevelopmental outcomes in premature infants. The quality of the maternal–infant interaction is affected not only by the infant’s developing neurobiology but also by the mother’s responses to the stressors surrounding a premature birth and mothering an infant in the NICU environment. Nurses can empower mothers to overcome these stressors, promote sensitive interactions with their infants, and facilitate neurodevelopment. Research is critically needed to develop and test nursing interventions directed at assisting mothers in supporting optimal neurodevelopment for their infants. [ABSTRACT FROM PUBLISHER]

Background: Hair cortisol is a measure of chronic or repeated hypothalamic--pituitary--adrenal axis activation in response to physical or psychological stressors. Hair cortisol has been successfully used as a measure of chronic stress in adults and children; however, its use as a valid measure in preterm infants has been limited by challenges in measuring cortisol in the low mass samples collectable from these infants. Objectives: The purpose of this report is to present a novel protocol for the measurement of hair cortisol in very low mass hair samples. Methods: Small changes were made to previously published protocols. After washing and pulverizing the hair samples, a double methanol cortisol extraction was performed. Samples were spiked with a known quantity of cortisol and analyzed in duplicate using an enzyme-linked immunosorbent assay. Results: Hair cortisol was detectable in samples weighing between 0.4 and 10.9 mg. The mean cortisol level was 23.74 pg/mg hair (SD = 26.38). Discussion: With small changes to previously published laboratory protocols, cortisol is quantifiable in low mass hair samples from preterm infants. This technical advance is an important step toward quantifying the stress experiences of hospitalized preterm infants. [ABSTRACT FROM AUTHOR]