BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Netw Open. 2022 Oct 3;5(10):e2238088. doi: 10.1001/jamanetworkopen.2022.38088.
Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks' gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown.
To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association.
DESIGN, SETTING, AND PARTICIPANTS: In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks' gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women's Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021.
Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years.
A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = -5.47; 95% CI, -9.44 to -1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years.
In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.
在 24-32 孕周出生的极早产儿中，存在内化（焦虑和/或抑郁）行为。新生儿重症监护病房（NICU）中与程序性疼痛相关的压力与该人群的长期内化问题有关；然而，在幼儿期是否有支持性的育儿行为和较低的育儿压力会减轻整个儿童期内化行为的发展，目前尚不清楚。
研究新生儿疼痛相关压力是否与 1.5、3.0、4.5 和 8.0 岁时的内化行为轨迹相关，以及在 1.5 和 3.0 岁时支持性的育儿行为和较低的育儿压力是否会减轻这种关联。
设计、地点和参与者：在这项前瞻性纵向队列研究中，于 2006 年 8 月 16 日至 2013 年 9 月 9 日从加拿大温哥华的 BC 妇女医院招募了早产儿（出生于 24-32 孕周），并在 1.5、3.0、4.5 和 8.0 岁时进行随访。该研究在三级新生儿重症监护病房进行，在新生儿随访计划中进行了连续的发育评估。数据分析于 2021 年 8 月至 12 月进行。
1.5、3.0、4.5 和 8.0 岁时，父母用儿童行为检查表报告孩子的内化行为。
共招募了 234 名新生儿，186 名儿童（101 名男孩[54%]）在 1.5 岁（159 名儿童）、3.0 岁（169 名儿童）、4.5 岁（162 名儿童）和 8.0 岁（153 名儿童）时被纳入当前研究。在考虑与早产相关的临床因素后，新生儿疼痛相关压力越大，各年龄段的内化行为越多（B=4.95；95%CI，0.76 至 9.14）。1.5 岁时较高的育儿压力（B=0.17；95%CI，0.11 至 0.23）和 3.0 岁时不太支持的父母环境（较少的敏感性、结构、非侵入性、非敌意和较高的育儿压力；B=-5.47；95%CI，-9.44 至-1.51）与整个发展过程中至 8.0 岁的内化问题更严重有关。
在这项针对非常早产儿的队列研究中，反复出现的新生儿疼痛相关压力与整个幼儿期至 8.0 岁的持续内化行为问题有关。在幼儿期，支持性的育儿行为与更好的长期行为结果有关，而较高的育儿压力与该人群中更多的儿童焦虑和/或抑郁行为有关。这些发现强调了预防早产儿疼痛的必要性，并为未来有针对性的以父母为导向的行为干预措施的发展提供了信息。
