title: Neonatal intensive care unit stress is associated with brain development in preterm infants.
abstract: OBJECTIVE
  Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner.
  
  
  METHODS
  In this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations.
  
  
  RESULTS
  Exposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination.
  
  
  CONCLUSIONS
  Exposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted.
authors: Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Ave., St Louis, MO 63110, USA.
authors: Gillian C
authors: GC
authors: Smith
authors: Jordan
authors: J
authors: Gutovich
authors: Christopher
authors: C
authors: Smyser
authors: Roberta
authors: R
authors: Pineda
authors: Carol
authors: C
authors: Newnham
authors: Tiong H
authors: TH
authors: Tjoeng
authors: Claudine
authors: C
authors: Vavasseur
authors: Michael
authors: M
authors: Wallendorf
authors: Jeffrey
authors: J
authors: Neil
authors: Terrie
authors: T
authors: Inder
mesh_terms: D001921:Brain / Q000473:pathology*; D002658:Developmental Disabilities / Q000473:pathology* / Q000523:psychology; D005260:Female; D006801:Humans; D018730:Infant Behavior / Q000523:psychology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development* / Q000523:psychology; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors