Neonatal stress: a concept analysis

Neonates and young infants are particularly vulnerable to stress because their immature neurological and physiological systems limit their capacity to regulate responses to environmental and caregiving stimuli. However, existing conceptualizations of neonatal stress do not consistently differentiate stressor exposure, adaptive responses, defining attributes of stress, and its consequences. This conceptual ambiguity may impede accurate assessment and limit comparability across studies. Clarifying the concept of neonatal stress is therefore essential to advance conceptual understanding and inform developmentally appropriate neonatal care. This study aimed to clarify the conceptual and operational definitions of neonatal stress in neonatal care settings. This concept analysis employed Walker and Avant’s [43] eight-step method to identify the defining attributes, cases, antecedents, consequences, and empirical referents of neonatal stress. A comprehensive literature search was conducted in PubMed, CINAHL, and Scopus from inception to June 16, 2026, using predefined search terms. Additional records were identified through website and manual searches and citation tracking. Twenty-seven records were included, comprising 24 records used for formal data extraction and three additional sources for definitional and theoretical clarification. Neonatal stress is operationally defined as a multidimensional response to internal or external demands that challenge physiological and developmental regulation, manifested through physiological and behavioral dysregulation. Biological stress-response activation serves as a complementary indicator rather than a defining attribute. Antecedents include environmental stressors and medical and nursing experiences, while infant-related physiological and developmental vulnerability acts as a contextual modifier. Consequences include short-term functional disruption and potential longer-term effects on neurodevelopment and self-regulation. Empirical referents encompass stressor exposure, acute stress responses, and cumulative or chronic stress burden. This concept analysis offers a conceptual framework for understanding neonatal stress and distinguishing it from related concepts. The findings may contribute to the theoretical development of neonatal nursing and inform future research and clinical considerations regarding neonatal stress. Further research is needed to refine and validate the identified attributes and indicators and to support the development of more robust approaches to assessing neonatal stress in vulnerable newborns.