Understanding infant stress in intensive care - Children's National

Critically ill infants who must spend their early days after birth in an intensive care environment such as neonatal intensive care unit (NICU), pediatric intensive care unit (PICU) or cardiac intensive care unit (CICU) face a multitude of overlapping stressors that can impact long-term neurodevelopment and well-being. A comprehensive study of available peer-reviewed research found several common categories of stressors for all intensive care environments, specifically based on data from the NICU and PICU. However, the nurse-researchers did not find any studies looking at the additional challenges faced by infants with congenital heart disease who begin their lives in the CICU.

The study, conducted by cardiac intensive care providers at Children's National Hospital, including lead author Christine Riley, PhD, RN, APRN, a nurse practitioner in the Cardiac Intensive Care Unit (CICU), reiterates the importance of understanding these stressors, how they impact already fragile newborns and how best to mitigate them and give every infant their best chance to thrive during and after an intensive care unit stay.

Why it matters

The findings, that infants in intensive care face a multitude of overlapping stressors caused by their environment, routine care and painful procedures, show that these vulnerable patients experience a significant cumulative stress burden. As the authors note, these stressful encounters have profound short- and long-term physiological and neurodevelopmental impacts, highlighting the importance of finding these sources of stress and taking steps to reduce them wherever possible. They write that efforts to do so are, "fundamental to improving patient care and optimizing recovery in this vulnerable population."

The review also revealed a missed opportunity in the research to date - the specific experiences of infants with congenital heart disease in the CICU. The unique anatomy of and different standards of care required for babies born with heart disease likely create additional stress factors influencing both short- and long-term growth and development.

Children's National leads the way

Dr. Riley and colleagues point out that, "studies to date overwhelmingly focus on preterm infants in neonatal intensive care settings, with limited research addressing the stressful experiences of infants with congenital heart disease, highlighting a crucial area for future investigation."

An innovative nurse-led clinical research program in the CICU at Children's National brings bedside care providers and families together in the unit for collaborations that will focus on identifying those CICU-specific stressors and create efforts to improve the neurodevelopment and long-term quality of life for infants who start their lives there.

The program's research portfolio seeks to define and measure stress and the impact of the stress burden for both families and infants. The program hopes to also develop wellness tools for families that can be administered as part of routine bedside care to help set parents and their babies up for greater resilience in the face of current and future challenges.

Read the study, Understanding Infant Stress in Neonatal and Pediatric Intensive Care: A Scoping Review, in the journal Intensive Care Medicine - Paediatric and Neonatal.