Cong Xiaomei, Wu Jing, Vittner Dorothy, Xu Wanli, Hussain Naveed, Galvin Shari, Fitzsimons Megan, McGrath Jacqueline M, Henderson Wendy A
School of Nursing, University of Connecticut, Storrs, CT, United States; Institute for Systems Genomics, University of Connecticut, Farmington, CT, United States; School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, United States.
Department of Statistics, University of Connecticut, Storrs, CT, United States.
Early Hum Dev. 2017 May;108:9-16. doi: 10.1016/j.earlhumdev.2017.03.003. Epub 2017 Mar 23.
Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU.
A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes.
Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97±2.30 procedures) and cumulative times of chronic/stressful exposure (42.59±15.02h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p<0.05) and habituation responses (p<0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p<0.01-0.05).
Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes.
在新生儿重症监护病房（NICU）中，脆弱的早产儿在其发育的关键时期会经历反复且持续时间较长的疼痛/应激刺激。累积的疼痛/应激源对神经发育改变的影响尚不清楚。本研究的目的是调查早期生活中的疼痛/应激经历对NICU中早产儿神经行为结局的影响。
对50名早产儿（胎龄28⁰/₇ - 32⁶/₇周）进行了一项前瞻性探索性研究，这些婴儿在出生时被招募并随访四周。每天测量累积疼痛/应激源（NICU婴儿应激源量表），并在孕龄36 - 37周时检查神经发育结局（NICU网络神经行为量表）。对随时间经历的疼痛/应激源分布以及疼痛/应激源与神经行为结局之间的联系进行了数据分析。
早产儿在NICU中经历了高度的疼痛/应激源，无论是每日急性事件的数量（22.97±2.30次操作）还是慢性/应激暴露的累积时间（42.59±15.02小时）。早期生活中经历的急性和慢性疼痛/应激均对神经行为结局有显著影响，特别是在应激/戒断方面（p<0.05）和习惯化反应方面（p<0.01），同时，直接母乳喂养和皮肤接触式抱持也与习惯化显著相关（p<0.01 - 0.05）。
了解早期生活经历改变神经发育背后的机制，将有助于临床医生制定有针对性的神经保护策略和个性化干预措施，以改善婴儿的发育结局。
