Relationships Between NICU Infant Stressors and Childhood Behavior and Development

BACKGROUND: Preterm infants face many stressful experiences in the neonatal intensive care unit (NICU). Critical aspects of brain growth and development may be affected by stressor exposure. Longer term neurodevelopmental effects may result. PURPOSE: The aims were to examine relationships between NICU stressor scores and childhood behavior and neurodevelopment at 4 years of age in a cohort of preterm infants. METHODS: We measured daily stress events with the Neonatal Infant Stress Scale (NISS) in 83 preterm infants over the first 6 weeks of life. Twenty-five of these children were followed up at 4 years of age the Child Behavior Checklist (CBCL) and the Battelle Developmental Index-Screening Test (BDI-2 ST). RESULTS: The cumulative NISS score was significantly correlated with both childhood scales in unadjusted models, but the CBCL and BDI-2 ST were not correlated with each other, suggesting they measured different constructs. Gestational age (GA) and time until full enteral feeding were the only consistent infant variables significantly associated with the CBCL scales and were selected as covariates in the regression models. Only the Score for Neonatal Physiology with Perinatal Extension (SNAPPE-II) was significantly associated with the BDI-2 ST personal-social, motor, communication, and total scales and was selected as the covariate in the regression models. Hierarchical regressions on CBCL internalizing, externalizing, and total behavior scores and BDI-2 ST scales showed relationships between the NISS and both scales, but other factors influenced these relationships, including GA, SNAPPE-II, and length of time to enteral feeding. IMPLICATIONS FOR PRACTICE AND RESEARCH: The amount and nature of neonatal stress may have impacts on neurodevelopment at 4 years of age. Limitations were the small sample size. Further larger studies of neonatal stress and neurodevelopment are warranted. Practice implications would be to ensure efforts to reduce unnecessary stress during the NICU stay and to provide developmental support as these children grow.