A New Way of Thinking About Complications of Prematurity

Abstract

The morbidity and mortality of preterm infants are impacted by their ability to maintain physiologic homeostasis using metabolic, endocrine, and immunologic mechanisms independent of the mother's placenta. Exploring McEwen's allostatic load model in preterm infants provides a new way to understand the altered physiologic processes associated with frequently occurring complications of prematurity such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. The purpose of this article is to present a new model to enhance understanding of the altered physiologic processes associated with complications of prematurity. The model of allostatic load and complications of prematurity was derived to explore the relationship between general stress of prematurity and complications of prematurity. The proposed model uses the concepts of general stress of prematurity, allostasis, physiologic response patterns (adaptive-maladaptive), allostatic load, and complications of prematurity. These concepts are defined and theoretical relationships in the proposed model are interpreted using the four maladaptive response patterns of repeated hits, lack of adaptation, prolonged response, and inadequate response. Empirical evidence for cortisol, inflammation, and oxidative stress responses are used to support the theoretical relationships. The proposed model provides a new way of thinking about physiologic dysregulation in preterm infants. The ability to describe and understand complex physiologic mechanisms involved in complications of prematurity is essential for research. Advancing the knowledge of complications of prematurity will advance clinical practice and research and lead to testing of interventions to reduce negative outcomes in preterm infants.

Feeding intolerance, inflammation, and neurobehaviors in preterm infants

“…The theoretical framework used for the analysis was the model of Allostatic Load and Complications of Prematurity (Moore et al, 2014). The model, described above, suggests that general stress of prematurity leads to physiologic dysregulation and complications of prematurity from the ‘wear and tear’ of chronic dysregulation.…”

“…Researchers have examined FI as a stress-related disease of the gastrointestinal (GI) tract using the theoretical model of Allostatic Load and Complications of Prematurity (Moore et al, 2014). This model posits that complications of prematurity, such as FI, are associated with physiologic dysregulation from chronic stress.…”

“…Although preterm infants with FI that does not progress to surgical NEC are believed to have better neurodevelopmental outcomes compared to infants with surgical NEC (Rees et al, 2007; Tobiansky et al, 1995; Wadhawan et al, 2014), little is known about the relationship between FI in preterm infants and neurodevelopment in the first week of life. However, the Allostatic Load and Complications of Prematurity model (Moore et al, 2014) posits that general stress of prematurity and exposure to stress in utero negatively affect outcomes in preterm infants, including FI and neurodevelopment. Identifying relationships between FI, inflammation, and early measures of neurodevelopment may provide the basis for novel and clinically relevant assessments for NICU clinicians and staff.…”

Comparison of cortisol samples in the first two weeks of life in preterm infants

“…The essential theme of these concepts is that negative prenatal and neonatal experiences may be associated with structural and functional alterations in the brain, which in turn, may negatively impact long-term health (1)(2)(3). Preterm infants endure numerous and accumulating types of physical, psychological, and physiological stress during critical periods of brain and nervous system development (3,4). Hence, the pivotal role that stress plays in driving negative outcomes in preterm infants must be further understood.…”

The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress‐induced neurodevelopmental impairment in preterm infants

“…We are aware of only one other model that describes the effect of neonatal stress exposure on preterm infant outcomes (Moore, Berger, & Wilson, ). The model by Moore et al () explains the effect of neonatal stress exposure using allostatic load as the central concept.…”