Casavant Sharon G, Cong Xiaomei, Fitch Roslyn H, Moore James, Rosenkrantz Ted, Starkweather Angela
1 School of Nursing, University of Connecticut, Storrs, CT, USA.
2 Neonatal Intensive Care Unit, The Hospital of Central Connecticut, New Britain, CT, USA.
Biol Res Nurs. 2019 Mar;21(2):210-223. doi: 10.1177/1099800418824415. Epub 2019 Jan 17.
Every year, an estimated 15 million babies are born preterm (<37 weeks' gestational age) globally. These preterm infants are exposed to repeated stressful and often painful procedures as part of routine life-saving care within the neonatal intensive care unit (NICU). Low thresholds for tactile and nociceptive input make it more difficult for neonates to discriminate between noxious and nonnoxious stimuli, which can result in continuous activation of stress responses in an attempt to achieve stability through adaptation, or allostasis. Rapidly reoccurring stressors can render stress-response systems over- or underactive, creating wear and tear, or allostatic load. A better understanding of biomarkers related to allostatic load might aid in early detection and prevention/alleviation of allostatic load in this population.
To identify stress biomarkers that have been studied in preterm infants at different time points in the NICU and as long-term outcome measures.
METHOD/SEARCH STRATEGY: Systematic searches were conducted of PubMed, CINAHL, SCOPUS, and PsychInfo databases.
FINDINGS/RESULTS: Twenty-one studies met inclusion criteria for this review. Several putative biomarkers were identified, including cortisol levels, epigenetic markers, brain microstructure, markers of oxidative stress, and the brain-gut-microbiome axis.
The interaction of disease with therapeutic interventions may inadvertently increase infant allostatic load. In addition to human studies, future research should leverage newly available large data sets to conduct additional analyses.
全球每年估计有1500万婴儿早产（胎龄<37周）。作为新生儿重症监护病房（NICU）常规挽救生命护理的一部分，这些早产儿会经历反复的应激性且通常是痛苦的操作。新生儿对触觉和伤害性刺激的阈值较低，这使得他们更难区分有害和无害刺激，这可能导致应激反应持续激活，试图通过适应或稳态适应来实现稳定。快速反复出现的应激源会使应激反应系统过度活跃或活动不足，造成损耗或稳态负荷。更好地了解与稳态负荷相关的生物标志物可能有助于早期发现和预防/减轻该人群的稳态负荷。
确定在NICU不同时间点对早产儿进行研究并作为长期结局指标的应激生物标志物。
方法/搜索策略：对PubMed、CINAHL、SCOPUS和PsychInfo数据库进行系统检索。
21项研究符合本综述的纳入标准。确定了几种假定的生物标志物，包括皮质醇水平、表观遗传标志物、脑微观结构、氧化应激标志物以及脑-肠-微生物群轴。
疾病与治疗干预的相互作用可能会无意中增加婴儿的稳态负荷。除了人体研究外，未来的研究应利用新获得的大数据集进行更多分析。
