Neonatal Stress, Health, and Development in Preterms: A Systematic Review

Dokkum, Nienke H. van; Kroon, Marlou L. A. de; Reijneveld, Sijmen A.; Bos, Arend F.

doi:10.1542/peds.2021-050414

Cited by 22 publications

(18 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may have implications for future treatment in the NICU as well, because the HPA axis is necessary to cope with stressful stimuli. Without this adaptive mechanism properly developed, infants may not be able to regulate stress, and this may in turn hamper neurodevelopment, evidenced by a wide range of effects of neonatal stress exposure ( 33 ). The hypothesis that exposure to stress is related to hypomethylation of the NR3C1 gene is also strengthened by postnatal findings in preterm infants showing that increased stress exposure during NICU stay leads to hypomethylation of the NR3C1 gene ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Differential Placental DNA Methylation of NR3C1 in Extremely Preterm Infants With Poorer Neurological Functioning

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundUnderstanding underlying mechanisms of neurodevelopmental impairment following preterm birth may enhance opportunities for targeted interventions. We aimed to assess whether placental DNA methylation of selected genes affected early neurological functioning in preterm infants.MethodsWe included 43 infants, with gestational age <30 weeks and/or birth weight <1,000 g and placental samples at birth. We selected genes based on their associations with several prenatal conditions that may be related to poor neurodevelopmental outcomes. We determined DNA methylation using pyrosequencing, and neurological functioning at 3 months post-term using Prechtl's General Movement Assessment, including the Motor Optimality Score-Revised (MOS-R).ResultsTwenty-four infants had atypical MOS-R, 19 infants had near-optimal MOS-R. We identified differences in average methylation of NR3C1 (encoding for the glucocorticoid receptor) [3.3% (95%-CI: 2.4%−3.9%) for near-optimal vs. 2.3% (95%-CI: 1.7%−3.0%), p = 0.008 for atypical], and at three of the five individual CpG-sites. For EPO, SLC6A3, TLR4, VEGFA, LEP and HSD11B2 we found no differences between the groups.ConclusionHypomethylation of NR3C1 in placental tissue is associated with poorer neurological functioning at 3 months post-term in extremely preterm infants. Alleviating stress during pregnancy and its impact on preterm infants and their neurodevelopmental outcomes should be further investigated.

show abstract

Section: Discussionmentioning

confidence: 99%

Differential Placental DNA Methylation of NR3C1 in Extremely Preterm Infants With Poorer Neurological Functioning

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Researchers operationalize stress exposure using a variety of measures. While the count of skin-breaking procedures is the most common operational definition of stress exposure, 13 the specific procedures included as "skin-breaking" in individual studies vary and often include invasive procedures that do not actually break the skin. 3,14,15 For this study, stress exposure is defined as the number of invasive procedures-that is, all procedures involving the entrance of a foreign object into the body.…”

Section: What This Study Addsmentioning

confidence: 99%

Predictors of Stress Exposure in Hospitalized Preterm Infants

Nist,

Harrison,

Shoben

et al. 2023

Advances in Neonatal Care

View full text Add to dashboard Cite

Background: Stress exposure in the neonatal intensive care unit (NICU) is associated with poor outcomes in preterm infants. However, factors predicting subsequent NICU stress exposure have not been identified. Purpose: To characterize NICU stressors experienced by preterm infants during the first 2 weeks of life and identify demographic, perinatal, and institutional variables associated with stress exposure. Methods: A secondary analysis of data from a nonexperimental, prospective study was conducted using data from 60 very preterm infants born 28 to 31 weeks gestational age. Stress exposures during the first 2 weeks of life, operationalized as number of invasive procedures, were characterized by type and quantity for each infant using data extracted from electronic health records. Associations between number of invasive procedures and demographic, perinatal, or institutional variables were analyzed using linear regressions with robust standard errors. Results: Preterm infants experienced, on average, 98 (SD = 41.8) invasive procedures. Of these invasive procedures, nasal and/or oral suctioning episodes (58.1%), followed by skin-breaking procedures (32.6%), were most frequent. Differences in the number of invasive procedures were found for maternal race; infants born to Black mothers experienced fewer total invasive procedures than infants born to White mothers. The number of invasive procedures also varied across NICUs. Implications for Practice and Research: Preterm infant stress exposure differed by maternal race and NICU, consistent with research findings of differential treatment of diverse infants. Further research is needed to understand the reasons for these differences and to identify best practices to standardize neonatal care.

show abstract

“…16 The risk for social, emotional, and cognitive impairment is higher for infants requiring NICU hospitalization than do other infants and is associated with poorer cognitive, motor, emotional, and behavioral development later in life. 17 Furthermore, emerging evidence suggests that individuals born prematurely are at an increased risk for chronic health disorders and mortality in early and midadulthood. 18 Although an NICU hospitalization may be unavoidable, and thus there is no way to prevent this ACE exposure, acknowledgment of this exposure can help families and providers to mitigate the long-term effects.…”

Section: Applying the Ace Framework To The Nicumentioning

confidence: 99%

“…These repeated and aberrant stressful experiences during the critical time of neuronal plasticity and brain growth then biologically embed the stress responses of the hypothalamus–pituitary–adrenal axis, altering long-term neurodevelopment 16. The risk for social, emotional, and cognitive impairment is higher for infants requiring NICU hospitalization than do other infants and is associated with poorer cognitive, motor, emotional, and behavioral development later in life 17. Furthermore, emerging evidence suggests that individuals born prematurely are at an increased risk for chronic health disorders and mortality in early and mid-adulthood 18.…”

Section: Applying the Ace Framework To The Nicumentioning

confidence: 99%

Application of the Adverse Childhood Experiences Framework to the NICU

Malin,

Vittner,

Darilek

et al. 2023

Advances in Neonatal Care

View full text Add to dashboard Cite

Background: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. Purpose: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. Methods: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. Results: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. Implications for Practice and Research: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

show abstract

Neonatal Stress, Health, and Development in Preterms: A Systematic Review

Cited by 22 publications

References 59 publications

Differential Placental DNA Methylation of NR3C1 in Extremely Preterm Infants With Poorer Neurological Functioning

Differential Placental DNA Methylation of NR3C1 in Extremely Preterm Infants With Poorer Neurological Functioning

Predictors of Stress Exposure in Hospitalized Preterm Infants

Application of the Adverse Childhood Experiences Framework to the NICU

Contact Info

Product

Resources

About