The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU
The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU
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DOI：
10.1016/j.earlhumdev.2017.03.003
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发表时间：
2017-05-01
影响因子：
2.5
通讯作者：
Henderson, Wendy A.
中科院分区：
文献类型：
--
作者：
Cong, Xiaomei;Wu, Jing;Henderson, Wendy A.
背景：脆弱的早产儿在新生儿重症监护病房 (NICU) 中的发育关键时期经历反复且长时间的疼痛/压力刺激。累积的疼痛/压力源对神经发育改变的影响仍不清楚。该研究的目的是调查早产儿痛苦/压力经历对 NICU 早产儿神经行为结局的影响。方法：对 50 名早产儿（胎龄 28 0/7-32 6/7 周）进行了一项前瞻性探索性研究，这些早产儿在出生时被招募，并随访 4 周。每天测量累积疼痛/压力源（NICU 婴儿压力源量表），并在月经后 36-37 周检查神经发育结果（NICU 网络神经行为量表）。对随时间经历的疼痛/压力源的分布以及疼痛/压力源与神经行为结果之间的联系进行数据分析。结果：早产儿在 NICU 中经历了高度的疼痛/压力源，无论是每日急性事件的数量（22.97 +/- 2.30 次手术）还是慢性/压力暴露的累积时间（42.59 +/- 15.02 小时）。早年经历的急性和慢性疼痛/压力对神经行为结果有显着影响，特别是在压力/禁欲（p < 0.05）和习惯反应（p < 0.01）方面，同时，直接母乳喂养和皮肤接触也与习惯显着相关（p < 0.01-0.05）。结论：了解早期生活经历改变神经发育的机制将有助于临床医生制定有针对性的神经保护策略和个体化策略。改善婴儿发育结果的干预措施。 (C) 2017 Elsevier B.V. 保留所有权利。
Background: Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU.Methods: A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7 weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37 weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes.Results: Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97 +/- 2.30 procedures) and cumulative times of chronic/stressful exposure (42.59 +/- 15.02 h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p < 0.05) and habituation responses (p < 0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p < 0.01-0.05).onclusion: Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes. (C) 2017 Elsevier B.V. All rights reserved.