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Multicenter Study
. 2025 Feb 13;184(3):196.
doi: 10.1007/s00431-025-06018-7.

Exposure to clinical stressors during NICU admission in preterm infants

Naomi J Meesters  1 , Gerbrich E van den Bosch  1 , Maria Luisa Tataranno  2 , Chris H P van den Akker  3 , Christ-Jan van Ganzewinkel  4 , Judith A Ten Barge  1 , Frank A B A Schuerman  5 , Henriette van Zanten  6 , Willem P de Boode  7 , Marlou M A Raets  8 , Peter H Dijk  9 , Joost van Rosmalen  10   11 , Marijn J Vermeulen  12 , Wes Onland  3   13 , Lotte Haverman  14 , Irwin K M Reiss  1 , Anton H van Kaam  3 , Manon Benders  2 , Monique van Dijk  1 , Sinno H P Simons  15 ; HIPPO study group
Affiliations
Multicenter Study

Exposure to clinical stressors during NICU admission in preterm infants

Naomi J Meesters et al. Eur J Pediatr. .

Abstract

This study aims to quantify stress exposure related to clinical stressors in preterm infants during NICU admission and identify risk factors for high stress exposure. In this national cohort study, preterm infants (gestational age < 29 weeks) were prospectively followed during the first 28 days of their admission to one of the 10 NICUs in the Netherlands. The NeO-stress score, consisting of 38 clinical stressors graded with a severity index, was applied to describe stress exposure. We assessed the impact of infant characteristics at birth and postnatal age on NeO-stress scores using linear mixed modelling. In total, 446 infants were included with a median gestational age of 27+2 weeks (IQR 26+2-28+2). The median NeO-stress score per day was 61 (IQR 39-87) and highest (74, IQR 52-101) on the day of admission. Nasal/oral (37%) and endotracheal (14%) suctioning were key contributors to the cumulative NeO-stress scores. Linear mixed modelling showed that lower gestational age (B = -0.69, 95% CI - 0.94-0.44, p < 0.001), no antenatal administration of corticosteroids (B = 13.2, 95% CI 3.2-23.1, p = 0.010) and lower 5-min Apgar score (B = - 1.6, 95% CI - 3.0-0.25, p = 0.02) were significantly related with higher daily NeO-stress scores. Our model predicts that the NeO-stress score increases over time for the youngest infants.

Conclusion: Stress exposure in preterm infants during NICU admission varies over time with infants with the lowest gestational age at risk for experiencing the highest levels of stress throughout NICU admission. This highlights the importance stress reduction and provides opportunities for future interventions aimed at reducing stress exposure.

What is known: • Preterm birth and admission to a Neonatal Intensive Care Unit is very stressful. • High stress exposure in neonatal life is associated with adverse long term outcome.

What is new: • Stress exposure is highest in infants with the youngest gestational ages where it remains high or even increases during the first month of life. • Lower gestational age, no antenatal administration of corticosteroids and lower 5-min Apgar score were significantly related with higher daily NeO-stress scores.

Keywords: NICU; Pain; Prematurity; Stress.

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Conflict of interest statement

Declarations. Ethics approval: The medical ethical committee of the Erasmus MC waived the need for approval within the Dutch Law on research with humans (MEC-2019–0574) because the study was judged to be a non-interventional study without exposing infants to procedures or additional rules of behavior. The medical ethical committees of the other participating NICUs subsequently adhered to this decision. Consent to participate: Written permission was obtained from the parents. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion flowchart. * I.e. in case of palliative care or severe illness of the mother. ** I.e. no daytime presence of the parents. *** Permission to analyse the collected data until consent withdrawal
Fig. 2
Fig. 2
Mean NeO-stress scores (and 95% CI) per gestational age group for the first 28 days of life
See this image and copyright information in PMC

References

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