Risk factors for length of NICU stay of newborns: A systematic review

Meaningful clinical outcomes: perspectives of primary caregivers with lived experience of spontaneous preterm birth following spontaneous preterm labor

BACKGROUND

Patient-centered research is foundational to informing the measurement of clinical benefit in interventional studies. Understanding caregivers' lived experience of spontaneous preterm birth (sPTB) resulting from spontaneous preterm labor (sPTL) and characterizing their perspectives on the clinical outcomes of greatest importance and relevance are essential for advancing the development of interventions for the delay or prevention of sPTB.

OBJECTIVE

This mixed methods study aimed to identify which clinical outcomes deriving from a (hypothetical) successful sPTL intervention are most important and relevant from the caregiver perspective to advance the therapeutic landscape for sPTB resulting from sPTL.

STUDY DESIGN

A targeted literature review was conducted to obtain preliminary insights, which informed the content of semi-structured, qualitative, concept elicitation telephone interviews with primary caregivers in the United States who had a live, singleton sPTB between 23 and 36 weeks' gestational age resulting from sPTL. Primary caregivers were those who self-identified as the parent who gave birth to the child preterm, had assumed the primary caring and parenting responsibility since birth, and understood the child's health-related needs since birth. Interview transcripts were thematically analyzed.

RESULTS

Twenty-four primary caregivers were interviewed. Delaying delivery from sPTL onset was the clinical outcome most associated with a successful intervention for sPTL and considered most important by caregivers due to anticipated subsequent fetal, neonatal, and maternal benefits (which were also perceived as distinct benefits of an intervention). One to two days was typically considered the threshold defining a meaningful delay to delivery from sPTL onset. Additionally, caregivers did not view the individual components of the neonatal morbidity and mortality composite endpoint (historically used to measure clinical benefit in trials of sPTB interventions) as equally relevant to their children's experiences, or as equally important due to perceived differences in their severity and potential for causing further health complications.

CONCLUSIONS

This study centralizes the primary caregiver's voice regarding which clinical outcomes are most important and appropriate to measure for the demonstration of meaningful clinical benefit in interventional studies assessing the delay or prevention of sPTB. Specifically, caregivers perceived delaying delivery from sPTL onset, typically by a minimum of one or two days, as the most important clinical outcome. The findings confirm an unmet need for such interventions, provide a benchmark for defining a patient-perceived clinically meaningful time to delivery from sPTL onset, and establish the inadequacy of the traditional neonatal morbidity and mortality composite endpoint from the caregiver perspective. Specifically, caregivers perceived delaying delivery from sPTL onset, typically by a minimum of one or two days, as the most important clinical outcome. These insights are critical to evolving the therapeutic landscape for maternal and neonatal health, and informing regulatory decision-making on the selection of endpoints to demonstrate meaningful, patient-centered clinical benefit. Further research is necessary to incorporate weighting of the components of the neonatal morbidity and mortality composite endpoint that are most relevant to caregivers' experiences and to establish if, and to what extent, the surrogate endpoint of time to delivery from sPTL onset is reflective of neonatal clinical outcome.

Psychometric Testing of a Scale to Measure Family Resilience Among Parents of Preterm Infants in the NICU

We evaluated the psychometric properties of the French-Canadian Communication, Organization, and Intrafamilial Beliefs in Neonatology (COCINL) NICU family resilience scale. Participants included 88 parents of preterm infants hospitalized for more than 14 days. We administered the COCINL scale and validated questionnaires of psychological distress and of self-reported perception of family resilience. Psychometric testing included internal consistency, interrater reliability among couples, construct, divergent, and exploratory criterion validation. We found high internal consistency for each subscale and the total scale. Interrater reliability among 11 couples demonstrated moderate agreement. Strong correlations between subscales supported the internal structure, however not by exploratory factor analysis. Divergent validation was supported by moderate correlations with psychological distress scores. Exploratory sensitivity and specificity analysis indicated that the COCINL scale aligns with participants' perceptions of family resilience. We found the psychometric properties of the COCINL scale to be adequate for measuring NICU family resilience for research purposes. It provides an assessment of family resilience during the NICU hospitalization that can be used to guide nursing interventions to promote parents' mental health in a family-centered care approach.

Time series analysis for forecasting neonatal intensive care unit census and neonatal mortality

BACKGROUND

This study analyzes time series data related to NICU (Neonatal Intensive Care Unit) census numbers, hospitalization days, and mortality rates.

METHODS

We utilized seven years of retrospective daily NICU census data for model development, covering the period from March 2016 to December 2022, encompassing a total of 7,227 infants. We applied the best-fitting models of ARIMA (Auto Regressive Integrated Moving Average) and SARIMA (Seasonal ARIMA) to forecast census numbers, lengths of hospital stays, and mortality proportions. Additionally, we conducted regression time series analysis to explore the relationships among these variables.

RESULTS

The mortality proportion peaked in 2017 at 9.94%. The average duration of hospitalization was 12.42 days, with significant variability observed between deceased and surviving neonates. Multiple regression analysis indicated an inverse relationship between the number of hospitalizations and the duration of hospital stays, with a coefficient of -2.58 days (P-value < 0.001). There was also a notable correlation between longer hospital stays and increased mortality, with a regression coefficient (B) of 0.339 (P-value = 0.018). Time series analysis revealed a decreasing trend in mortality proportion in the NICU, alongside seasonal patterns in census numbers, which peaked during the winter months.

CONCLUSION

Seasonal variations were observed, with the highest admissions occurring in the winter months and the shortest hospital stays during this period. Additionally, longer hospital stays were associated with higher mortality. Forecasting using ARIMA and SARIMA models demonstrated strong predictive capabilities, highlighting the importance of effective resource planning to optimize outcomes in the NICU.

CLINICAL TRIAL NUMBER

Not applicable.

Pregnancy and Birth Outcomes Among Middle Eastern or North African Infants and Mothers in Quebec, Canada, 2008-2020

OBJECTIVES

The health status of Middle Eastern or North African (MENA) populations in Western countries is poorly understood. We assessed whether MENA infants and mothers have a greater risk of adverse pregnancy and birth outcomes than non-MENA infants and mothers in Quebec, Canada.

METHODS

We conducted a population-based observational study of 809 172 infants born to pregnant women in Quebec from 2008 through 2020. We identified infants in the MENA group based on self-reported mother tongue (Arabic or Turkish) and parents' country of birth (North African or Middle Eastern country). We compared infant and maternal outcomes, including gestational diabetes, cesarean delivery, preterm birth, severe maternal or neonatal morbidity, and other pregnancy and birth complications between the MENA and non-MENA groups. Using log-binomial regression models, we calculated risk ratios (RRs) and 95% CIs to measure the risk of adverse pregnancy and birth outcomes for the MENA group compared with the non-MENA group, adjusting for maternal age, comorbidity, and other patient characteristics.

RESULTS

Compared with the non-MENA group (n = 716 387), the MENA group (n = 92 785) had an elevated risk of gestational diabetes (RR = 1.51; 95% CI, 1.48-1.55), postterm birth (RR = 1.24; 95% CI, 1.08-1.42), and short-stay neonatal intensive care unit admission (RR = 1.91; 95% CI, 1.82-1.99). However, MENA infants were 15% to 50% less likely than non-MENA infants to be born preterm, have severe neonatal morbidity, and have a mother with preeclampsia or severe maternal morbidity.

CONCLUSIONS

Although findings among MENA infants and mothers in Quebec were reassuring overall, MENA infants and mothers may benefit from closer perinatal follow-up to improve complications of gestational diabetes.

Analysis of risk factors and establishment of predictive models for neonatal necrotizing enterocolitis: a retrospective study

BACKGROUND

Necrotizing enterocolitis (NEC) is a leading gastrointestinal condition in preterm infants, characterized by significant morbidity and mortality. Early recognition of risk factors is crucial for its prevention and prediction. This study focuses on identifying factors that contribute to the development of NEC in neonates.

METHODS

A case-control study that looked back at 144 newborns hospitalized to a Wuhan hospital between January 2010 and March 2023 for NEC was carried out. Over the same period, another 144 children without NEC were identified and selected as the non-NEC group for comparison, following a 1:1 pairing ratio. The relevant data from these two groups of newborns were compared. Univariate analysis was conducted using T-tests or χ2 tests, followed by multivariate logistic regression to determine independent risk factors and develop a clinical prediction model.

RESULTS

A total of 288 neonates (144 NEC and 144 non-NEC) were enrolled. The independent risk variables for NEC, as shown by the multivariate logistic regression analysis (p < 0.05), were Small for Gestational Age (SGA), neonatal sepsis, neonatal hyperbilirubinemia, and non-human milk (HM) feeding. Furthermore, ROC (receiver operating characteristic) analysis showed that the AUC (area under the curve) of the Logistic regression model predicting the effect of neonatal necrotizing enterocolitis was 0.746, suggesting a high level of discriminative ability in differentiating efficacy. This model can be instrumental in facilitating early identification of infants prone to developing NEC in clinical settings.

CONCLUSION

In conclusion, the risk factors associated with newborn NEC include SGA, neonatal sepsis, and non-HM feeding. Newborn hyperbilirubinemia may potentially serve as a protective factor against NEC.

Comparative Assessment of the Critical Condition of Newborns with Congenital Anomalies on the Basis of Different Scales

Objective: Various assessment scales have been developed to evaluate the severity of critical conditions in patients admitted to neonatal intensive care units (NICUs), predicting the length of stay, likelihood of complications, and death. Congenital anomalies, though a significant portion of NICU admissions, are often excluded from such studies. The aim of our study was to compare the informativeness of different scoring systems in the assessment of critical patients with congenital anomalies treated in the NICU, as well as their applicability in predicting complications and fatal outcomes. Materials and Methods: Between 2019 and 2022, we evaluated the severity of the critical condition of 921 newborns diagnosed with congenital anomalies at the Scientific Research Pediatric Institute named after K. Farajova using the National therapeutic intervention evaluation system (NTISS), scores for neonatal acute physiology (SNAPPE II), clinical risk index for babies (CRIB), and the mortality index for neonatal transportation score (MINT) scales. Results: Of the 921 neonates with congenital anomalies admitted to the NICU in critical condition, 271 (29.4%) were preterm (≤37 weeks) and 650 (70.6%) were term. In 921 patients diagnosed with congenital anomalies, the mean NTISS score according to the scales was 18.6; SNAPPE II 14.2; CRIB 4.6; MINT 6.9. In these patients, when the mean score of preterm and term births was compared according to gestational week, the SNAPPE II and MINT points were statistically significantly higher in preterm babies than terms. In the comparative analysis between the patients of the surviving and lethal groups, it was found that all the scales (SNAPPE II, NTISS, CRIB, MINT) were statistically significant. Conclusion: National therapeutic intervention evaluation system, SNAPPE II, CRIB, and MINT scales are useful in predicting mortality in newborns with congenital anomalies. However, these scales do not account for the severity of the congenital anomalies, system damage relationships, complication effects, or treatment needs (need for surgical intervention). Tailored scale usage corresponding to medical service levels in different countries would improve affordability and predictability.

Transforming the electronic health record from a documentation application to an automated diet program for personalizing neonatal nutrition and improving feeding administration safety through process improvement

Delivering adequate nutrition to preterm and sick neonates is critical for growth. Infants in the neonatal intensive care unit (NICU) require additional calories to supplement feedings for higher metabolic demands. Traditionally, clinicians enter free-text diet orders for a milk technician to formulate recipes, and dietitians manually calculate nutrition components to monitor growth. This daily process is complex and labor intensive with potential for error. Our goal was to develop an electronic health record (EHR)-integrated solution for entering feeding orders with automated nutrition calculations and mixing instructions. The EHR-integrated automated diet program (ADP) was created and implemented at a 52-bed level III academic NICU. The configuration of the parenteral nutrition orderable item within the EHR was adapted to generate personalized milk mixing recipes. Caloric, macronutrient, and micronutrient constituents were automatically calculated and displayed. To enhance administration safety, handwritten milk bottle patient labels were substituted with electronically generated and scannable patient labels. The program was further enhanced by calculating fortifier powder displacement factors to improve mixing precision. Order entry was optimized to allow for more complex mixing recipes and include a preference list of frequently ordered feeds. The EHR-ADP's safeguarded features allowed for catching multiple near-missed feeding administration errors. The NICU preterm neonate cohort had an average of 6-day decrease (P = 0.01) in the length of stay after implementation while maintaining the same weight gain velocity. The EHR-ADP may improve safety and efficiency; further improvements and wider utilization are needed to demonstrate the growth benefits of personalized nutrition.

Length of stay and its associated factors in the neonatal intensive care unit of Gadarif Hospital, Eastern Sudan: a retrospective study

BACKGROUND

Attention is increasingly paid to length of stay (LOS) in neonatal intensive care units (NICUs) across countries. Few published data on neonatal LOS exist in Africa, where there is a high burden of neonatal morbidity and mortality. Thus, this study investigated the factors associated with neonatal LOS in the NICU of Gadarif Hospital, Eastern Sudan.

METHODS

A hospital-based retrospective study was conducted at Gadarif Hospital in Eastern Sudan from May to December 2020. Sociodemographic, maternal, and neonatal data were obtained from the hospital records. Poisson regressions were used to determine the adjusted relative risk (aRR) values and 95.0% confidence intervals (CIs).

RESULTS

This study enrolled 333 neonates admitted to the NICU and discharged alive. The median (interquartile range [IQR]) of maternal age and parity was 27.0 (23.0‒30.0) years and 3 (2‒5), respectively. Of the 333 neonates, 160 (48.0%) were males; 136 (40.8%) were delivered via cesarean section; 258 (77.5%) had low Apgar scores, and 74 (22.2%) had birth asphyxia. There were 140 (42.0%) low birth weight (LBW) neonates and 133 (39.9%) preterm neonates. The LOS range was 1-29 days (mean = 5.1 days), and its median (IQR) was 4 (2‒7) days. The multivariate Poisson analysis showed that increasing maternal age (aRR = 1.02, 95% CI = 1.01‒1.05), LBW (aRR = 1.48, 95% CI = 1.16‒1.90), preterm delivery (aRR = 1.27, 95% CI = 1.01‒1.61), a low Apgar score (aRR = 1.32, 95% CI = 1.06‒1.42), and an increasing white blood cell (WBC) count (aRR = 1.001, 95% CI = 1.001‒1.002) were associated with LOS. Parity (aRR = 0.85, 95% CI = 0.80‒0.91) was inversely associated with LOS. However, neonatal jaundice and mode of delivery were associated with LOS only in the univariate analysis.

CONCLUSION

Increasing maternal age, preterm newborn, LBW, and a low Apgar score prolonged the LOS in this region of Sudan. Healthcare providers could leverage these identified factors to predict extended neonatal LOS in Eastern Sudan, enabling proactive interventions to enhance neonatal outcomes.

Determinants of neonatal mortality among hospitalised neonates with sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi: A mixed-methods study

Neonatal sepsis-related deaths remain a significant health problem contributing to higher morbidity and mortality rates, particularly in low resource settings, such as Malawi. However, there is limited information to associate risk factors and health system factors with mortality. This study investigated the risk factors associated with mortality and explored health system factors contributing to deaths among neonates with sepsis at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This mixed-method study utilised a convergent parallel approach to describe the determinants of neonatal mortality among neonates with sepsis. We selected this design because it allowed the researchers to triangulate, support and enhance the internal and external validity of the results. We retrospectively reviewed 237 neonatal records using a simple random sampling technique for cross-sectional quantitative data. Exploratory qualitative data was collected using a semi-structured interview guide from 10 purposively selected healthcare workers directly involved in providing neonatal care through in-depth interviews. Quantitative data were analysed using univariate and multivariate logistic regression in Stata v.14; qualitative data were analysed manually using a thematic analysis approach. We found that gestation age (OR 0.76 (95% CI: 0.58, 0.99), p-value = 0.040) and number of days spent in the hospital (OR 0.64 (95% CI: 0.48, 0.85), p-value = 0.002) were the most predictive risk factors. The qualitative inquiry showed the maternal behavioural factors; reporting late to hospital, cultural and religious beliefs; maternal health related factors: prolonged labour, unnecessary vaginal examinations, premature rupturing of membranes; Neonatal factors: prematurity, meconium aspiration, home deliveries and lastly, health system factors included delay in treatment, referrals and blood culture results, limited resources contributed to documented clinical outcomes. Determinants of neonatal mortality were gestation age, number of days spent in the hospital, maternal behavioural and health related, neonatal and health system factors. Reducing mortality among neonates with sepsis will require a multi-sectoral approach.

Efficacy of short-course antibiotics for culture-positive neonatal sepsis: A systematic review and meta-analysis

Sepsis is a common cause of neonatal mortality and morbidity. Though antibiotics are the mainstay of treatment in culture-positive neonatal sepsis, the dilemma persists for the optimum duration of antimicrobial therapy. The present study aimed to evaluate the efficacy of short-course antibiotics for uncomplicated culture-positive neonatal sepsis. This systematic review and meta-analysis (PROSPERO: CRD42023444899) identified, appraised, and synthesised the available evidence from randomised and quasi-randomised controlled trials related to the efficacy of short-course (7-10 days) versus standard-course (14 days) antibiotics for uncomplicated culture-positive neonatal sepsis on the rate of treatment failure, mortality, duration of hospitalisation, morbidities including antibiotics-related adverse events, long-term neurodevelopmental outcomes and cost analysis. Data were pooled using RevMan 5.4 software. Certainty of evidence (COE) for predefined outcomes was analysed by GRADE. Available evidence showed no significant difference in the rate of treatment failure between 7- to 10-day versus 14-day antibiotics courses [risk ratio (95% confidence interval, CI), 2.45 (0.93-6.47), I2 = 0%, six studies, n = 573, very low COE]. No incidence of death was reported in either treatment arm in the two included studies. Duration of hospitalisation was significantly shorter with the short-course antibiotics arm compared to standard-course [mean difference (95% CI), -3.88 (-4.22 to -3.54) days, I2 = 0%, five studies, n = 507, low COE]. Morbidities reported in the three studies were similar. Other outcomes were not reported. To conclude the evidence is very uncertain about the effect of short-course antibiotic regimen, compared to a standard-course, on the treatment failure rate in uncomplicated culture-positive neonatal sepsis. Adequately powered trials with outcomes including death and long-term neurodevelopmental impairment are needed.

Reasons and Factors Affecting the Neonatal Intensive Care Unit (NICU) Length of Stay of Full-Term Newborns: A Systematic Review

There is a significant challenge in predicting the duration of the neonatal hospital length of stay (LOS) due to the complicated factors that affect newborns. Most studies are conducted among pre-term neonates, in which the gestational age is lower than 37 weeks and the birth weight of patients is considered a major risk factor for a prolonged LOS. No previous systematic review of the literature was conducted among the full-term population. This review aims to determine the risk factors for neonatal intensive care unit (NICU) LOS from multiple studies affecting full-term patients. The included studies focused on assessing reasons and factors affecting the NICU LOS of newborns, including "full-term newborns." We included studies that considered the NICU LOS as the primary outcome. Both retrospective and prospective studies were eligible for inclusion. The risk of bias for the included studies was evaluated using the Quality in Prognosis Studies (QUIPS) tool suggested by the Cochrane Prognosis Methods Group. The literature search of the databases identified 637 potentially relevant articles, among which 10 met the inclusion criteria and were selected for this review. Among the 10 studies, three risk factors were identified: disease-related, parent-related, and inherent factors. These factors constitute a critical risk factor most widely studied and consistently associated with LOS for the full-term population. Our findings offer an updated extensive summary of this aspect that has not been considered in detail in the literature. In conclusion, several critical risk factors affecting neonatal LOS were discovered in the published studies in this systematic review. However, there is a need for more prospective studies with standardized approaches that are crucial to confirm these findings and help develop effective interventions.

Associations between sociodemographic characteristics and neonatal length of the stay

BACKGROUND

Infants with past NICU admission have a significantly higher risk of developing neurodevelopmental disorders. Studies have demonstrated an iatrogenic effect of the NICU environment on neurodevelopmental outcomes, even while accounting for physical factors. It is, therefore, critical that an infant's LOS is driven by physical needs versus sociodemographic barriers.

METHODS

We leveraged electronic health records and a backward selection regression model to explore physical and sociodemographic predictors of infant LOS.

RESULTS

Our results demonstrated that physical predictors (birthweight and ventilator use) accounted for the majority of variance in our model but that a sociodemographic predictor, mean visits per day, was also significant.

CONCLUSIONS

Infants who were visited more frequently experienced a shorter LOS, possibly due to increased parental involvement resulting in more individualized care and directly impacting infant stability and morbidity. By supporting visitation, we can reduce the costs of lengthy NICU hospitalizations while improving infant and parent health and well-being.

Factors affecting length of stay according to bronchopulmonary dysplasia severity: a nationwide cohort study in Korea

BACKGROUND

Longer hospitalizations for preterm infants with bronchopulmonary dysplasia (BPD) delay developmental outcomes, increase the risk for hospital-acquired complications, and exert a substantial socioeconomic burden. This study aimed to identify factors associated with an extended length of stay (LOS) at different levels of severity of BPD.

METHODS

A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.

RESULTS

A total of 4263 infants were diagnosed with BPD. For mild BPD, infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS [eadjusted β coefficients (adj β) 1.041; 95% confidence interval (CI): 0.01-0.08] and hydrocephalus (eadj β 1.094; 95% CI 0.01-0.17). In moderate BPD, infants administered steroids or with intraventricular hemorrhage required a longer LOS (eadj β 1.041; 95% CI 0.00-0.07 and eadj β 1.271; 95% CI 0.11-0.38, respectively). In severe BPD, infants with comorbidities required a longer LOS: pulmonary hypertension (eadj β 1.174; 95% CI 0.09-0.23), administrated steroid for BPD (eadj β 1.116; 95% CI 0.07-0.14), sepsis (eadj β 1.062; 95% CI 0.01-0.11), patent ductus arteriosus requiring surgical ligation (eadj β 1.041; 95% CI 0.00-0.08), and intraventricular hemorrhage (eadj β 1.016; 95% CI 0.05-0.26). Additionally, the higher the clinical risk index score, the longer the LOS needed for infants in all groups.

CONCLUSIONS

The factors affecting LOS differed according to the severity of BPD. Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.

Development and validation of a novel risk classification tool for predicting long length of stay in NICU blood transfusion infants

Newborns are as the primary recipients of blood transfusions. There is a possibility of an association between blood transfusion and unfavorable outcomes. Such complications not only imperil the lives of newborns but also cause long hospitalization. Our objective is to explore the predictor variables that may lead to extended hospital stays in neonatal intensive care unit (NICU) patients who have undergone blood transfusions and develop a predictive nomogram. A retrospective review of 539 neonates who underwent blood transfusion was conducted using median and interquartile ranges to describe their length of stay (LOS). Neonates with LOS above the 75th percentile (P75) were categorized as having a long LOS. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method was employed to screen variables and construct a risk model for long LOS. A multiple logistic regression prediction model was then constructed using the selected variables from the LASSO regression model. The significance of the prediction model was evaluated by calculating the area under the ROC curve (AUC) and assessing the confidence interval around the AUC. The calibration curve is used to further validate the model's calibration and predictability. The model's clinical effectiveness was assessed through decision curve analysis. To evaluate the generalizability of the model, fivefold cross-validation was employed. Internal validation of the models was performed using bootstrap validation. Among the 539 infants who received blood transfusions, 398 infants (P75) had a length of stay (LOS) within the normal range of 34 days, according to the interquartile range. However, 141 infants (P75) experienced long LOS beyond the normal range. The predictive model included six variables: gestational age (GA) (< 28 weeks), birth weight (BW) (< 1000 g), type of respiratory support, umbilical venous catheter (UVC), sepsis, and resuscitation frequency. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.851 (95% CI 0.805-0.891), and for the validation set, it was 0.859 (95% CI 0.789-0.920). Fivefold cross-validation indicates that the model has good generalization ability. The calibration curve demonstrated a strong correlation between the predicted risk and the observed actual risk, indicating good consistency. When the intervention threshold was set at 2%, the decision curve analysis indicated that the model had greater clinical utility. The results of our study have led to the development of a novel nomogram that can assist clinicians in predicting the probability of long hospitalization in blood transfused infants with reasonable accuracy. Our findings indicate that GA (< 28 weeks), BW(< 1000 g), type of respiratory support, UVC, sepsis, and resuscitation frequency are associated with a higher likelihood of extended hospital stays among newborns who have received blood transfusions.

Exposure to prenatal stressors and infant autonomic nervous system regulation of stress

OBJECTIVES

The purpose of this study was to determine the relationship between fetal exposure to maternal prenatal stressors and infant parasympathetic (PNS) and sympathetic (SNS) nervous function at 3 timepoints across the first year of life.

BACKGROUND

Autonomic nervous system impairments may mediate associations between gestational exposure to stressors and later infant health problems. Heart rate variability (HRV) provides a sensitive index of PNS and SNS function. However, no studies have assessed longitudinal associations between prenatal stressors and infant HRV measures of both PNS and SNS over the first year of life.

METHODS

During the third trimester of pregnancy, 233 women completed measures of life stressors and depression. At 1, 6 and 12 months of age, a stressor protocol was administered while infant electrocardiographic (ECG) data were collected from a baseline through a post-stressor period. HRV measures of PNS and SNS activity (HF, LF, LF/HF ratio) were generated from ECG data. We used multilevel regression to examine the aims, adjusting for maternal depression and neonatal morbidity.

RESULTS

There were no associations between prenatal stressors and any baseline or reactivity HRV metric over the infant's first year of life. However, exposure to more stressors was associated with lower post-stressor LF HRV at both 6 (β = -.44, p = .001) and 12 (β = -.37, p = .005) months of age.

CONCLUSIONS

Findings suggest potential alterations in development of the vagally mediated baroreflex function as a result of exposure to prenatal stressors, with implications for the infants' ability to generate a resilient recovery in response to stressors.