Improving outcomes for preterm infants: Mitigating stress exposure

Stress exposure in the neonatal intensive care unit (NICU) is ubiquitous and affects long-term outcomes for preterm infants. The NICU hospitalization occurs during a critical period of experience-dependent and experience-expectant development when the immature brain is particularly sensitive to environmental exposures, but the experiences of preterm infants are often poorly matched to their neurologic expectations. The mismatch between preterm infants' experiences and neurologic expectations may cause abnormal brain development and programming of the stress response systems. Routine nursing care and parental separation are two neurologically unexpected experiences that, while often overlooked, may be amenable to interventions, including system-level changes. To guide the development and implementation of effective interventions, it is necessary to understand how nurse caregiving practices and parental separation specifically contribute to the preterm infant's stress burden. The purpose of this paper is to provide an overview of the effects of routine nursing care and parental separation, two persistent NICU stressors, and offer recommendations for interventions that nurses and other care providers can use to mitigate the negative effects of these exposures.