Neonatal intensive care unit stress is associated with brain development in preterm infants

Authors

  • Gillian C. Smith BA,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
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  • Jordan Gutovich BA,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
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  • Christopher Smyser MD,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
    2. Department of Neurology, Washington University School of Medicine, St Louis, MO
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  • Roberta Pineda PhD, OTR/L,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
    2. Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO
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  • Carol Newnham BBsc, PhD,

    1. Parent-Infant Research Institute, Melbourne, Victoria, Australia
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  • Tiong H. Tjoeng MD, MPH,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
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  • Claudine Vavasseur MD,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
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  • Michael Wallendorf PhD,

    1. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
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  • Jeffrey Neil MD, PhD,

    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
    2. Department of Neurology, Washington University School of Medicine, St Louis, MO
    3. Department of Radiology, Washington University School of Medicine, St. Louis, MO
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  • Terrie Inder MD, PhD

    Corresponding author
    1. Department of Pediatrics, Washington University School of Medicine, St Louis, MO
    2. Department of Neurology, Washington University School of Medicine, St Louis, MO
    3. Department of Radiology, Washington University School of Medicine, St. Louis, MO
    • Department of Pediatrics, St Louis Children's Hospital, Washington University in St Louis, 660 South Euclid Ave, St Louis MO 63110
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Abstract

Objective:

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.

Methods:

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.

Results:

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.

Interpretation:

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;

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