Neonatal intensive care unit stress is associated with brain development in preterm infants
Version of Record online: 4 OCT 2011
Copyright © 2011 American Neurological Association
Annals of Neurology
Volume 70, Issue 4, pages 541–549, October 2011
How to Cite
Smith, G. C., Gutovich, J., Smyser, C., Pineda, R., Newnham, C., Tjoeng, T. H., Vavasseur, C., Wallendorf, M., Neil, J. and Inder, T. (2011), Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol., 70: 541–549. doi: 10.1002/ana.22545
- Issue online: 25 OCT 2011
- Version of Record online: 4 OCT 2011
- Manuscript Accepted: 15 JUL 2011
- Manuscript Revised: 1 JUN 2011
- Manuscript Received: 25 OCT 2010
Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner.
In this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations.
Exposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination.
Exposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted. ANN NEUROL 2011;