Montirosso R, Casini E, Del Prete A, Zanini R, Bellù R, Borgatti R
0-3 Centre for the Study of Social Emotional Development of the At-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy.
Department of Neonatal Care and Neonatal Intensive Care Unit, Manzoni Hospital, Lecco, Italy.
Eur J Pain. 2016 Jul;20(6):1010-21. doi: 10.1002/ejp.826. Epub 2016 Feb 5.
Very preterm infants are exposed to adverse stressful experiences, which may result in long-term behavioural outcomes. The developmental care practices, including pain management and environmental support, can minimize the effects of stress exposure. However, developmental care quality levels may vary among Neonatal Intensive Care Units (NICUs) and little is known about how differences in developmental care quality affect long-term behavioural outcomes. The aim of this study was to examine the relation between quality levels NICUs developmental care and behaviour problems at 18 months corrected age in preterm children.
The behaviour of 134 preterm children from 22 NICUs and 123 full-term controls was examined using the questionnaire Child Behaviour Checklist 1½-5. We compared the behavioural profile of children by splitting NICUs into units with high- and low quality of developmental care according to two main care factors: (1) infant centered care (ICC) index, and (2) infant pain management (IPM) index.
Preterm children from low-care units in IPM group reported higher scores in Internalizing Problems, compared to children from high-care units. No differences were found between preterm children from high-care in IPM and full-term children. No significant IPM effect was found for externalizing problems. No significant ICC effect emerged both for internalizing and externalizing problems.
Findings suggest that higher quality of developmental care related to infant pain management can mitigate behavioural problems at 18 months in children born preterm, to such an extent that preterm children exhibit a behavioural profile similar to that displayed by full-term children.
极早产儿会经历不良应激体验，这可能导致长期行为后果。包括疼痛管理和环境支持在内的发育照护措施，可以将应激暴露的影响降至最低。然而，新生儿重症监护病房（NICU）的发育照护质量水平可能存在差异，而关于发育照护质量差异如何影响长期行为后果，人们知之甚少。本研究的目的是探讨NICU发育照护质量水平与早产儿18个月矫正年龄时行为问题之间的关系。
使用儿童行为检查表1½ - 5对来自22个NICU的134名早产儿和123名足月儿对照的行为进行了检查。我们根据两个主要照护因素，将NICU分为发育照护质量高和低的单位，比较了儿童的行为特征：（1）以婴儿为中心的照护（ICC）指数，和（2）婴儿疼痛管理（IPM）指数。
与来自高照护单位的儿童相比，IPM组低照护单位的早产儿在内化问题上得分更高。IPM组高照护的早产儿与足月儿之间未发现差异。在外化问题上未发现显著的IPM效应。在内化和外化问题上均未发现显著的ICC效应。
研究结果表明，与婴儿疼痛管理相关的更高质量的发育照护可以减轻早产儿18个月时的行为问题，使早产儿的行为特征与足月儿相似。
