Neuroscience, University of British Columbia, Vancouver, BC, Canada Developmental Neurosciences & Child Health, Child & Family Research Institute, Vancouver, BC, Canada Pediatrics, University of British Columbia, Vancouver, BC, Canada Pediatrics, University of Toronto, Toronto, ON, Canada The Hospital for Sick Children, Toronto, ON, Canada B.C. Children's & Women's Hospitals, Vancouver, BC, Canada.
Pain. 2013 Sep;154(9):1831-1839. doi: 10.1016/j.pain.2013.05.050. Epub 2013 Jun 5.
Children born very preterm (≤ 32 weeks gestation) exhibit greater internalizing (anxious/depressed) behaviors compared to term-born peers as early as 2 years corrected age (CA); however, the role of early stress in the etiology of internalizing problems in preterm children remains unknown. Therefore, we examined the relationship between neonatal pain and internalizing behavior at 18 months CA in children born very preterm and examined whether parent behavior and stress moderated this relationship. Participants were 145 children (96 very preterm, 49 full term) assessed at 18 months CA. Neonatal data were obtained from medical and nursing chart review. Neonatal pain was defined as the number of skin-breaking procedures. Cognitive ability was measured with the Bayley Scales of Infant Development II. Parents completed the Parenting Stress Index III, Child Behavior Checklist 1.5-5, and participated in a videotaped play session with their child, which was coded using the Emotional Availability Scale IV. Very preterm children displayed greater Internalizing behaviors compared to full-term control children (P=.02). Parent Sensitivity and Nonhostility moderated the relationship between neonatal pain and Internalizing behavior (all P<.05); higher parent education (P<.03), lower Parenting Stress (P=.001), and fewer children in the home (P<.01) were associated with lower Internalizing behavior in very preterm children, after adjusting for neonatal medical confounders, gender, and child cognitive ability (all P>.05). Parent Emotional Availability and stress were not associated with Internalizing behaviors in full-term control children. Positive parent interaction and lower stress appears to ameliorate negative effects of neonatal pain on stress-sensitive behaviors in this vulnerable population.
早产儿（妊娠 32 周及以下）在出生后 2 年纠正年龄（CA）时，其内化（焦虑/抑郁）行为比足月儿更为明显；然而，早产儿内化问题的病因中早期应激的作用尚不清楚。因此，我们研究了新生儿疼痛与 18 个月 CA 时早产儿内化行为之间的关系，并探讨了父母行为和压力是否调节了这种关系。研究对象为 145 名儿童（96 名早产儿，49 名足月儿），在 18 个月 CA 时进行评估。新生儿数据通过医疗和护理图表回顾获得。新生儿疼痛定义为皮肤破损程序的数量。认知能力采用贝利婴幼儿发展量表 II 进行测量。父母完成了父母压力指数 III、儿童行为检查表 1.5-5，并与他们的孩子一起参加了录像游戏会议，该会议使用情感可用性量表 IV 进行了编码。与足月对照组相比，早产儿的内化行为更为明显（P=.02）。父母的敏感性和非敌意调节了新生儿疼痛与内化行为之间的关系（均 P<.05）；较高的父母教育水平（P<.03）、较低的父母压力（P=.001）和家中孩子较少（P<.01）与调整新生儿医疗混杂因素、性别和儿童认知能力后，早产儿的内化行为较低有关（均 P>.05）。父母的情感可用性和压力与足月对照组的内化行为无关。在这个脆弱的群体中，积极的父母互动和较低的压力似乎可以减轻新生儿疼痛对压力敏感行为的负面影响。
