Neonatal stress and coping in intensive care

Examples are given of research on (a) stressful procedures and assessments in the neonatal intensive care nursery and (b) natural caregiving stimulation and self-comforting behaviors that alleviate these stressful experiences. The data from the studies on stressful procedures and assessments revealed that (a) weaning from mechanical ventilation was associated with increased plasma cortisol levels; (b) heelsticks and tube insertions for gavage feedings were accompanied by decreases in oxygen tension (TcPO2); and (c) Brazelton neonatal behavior assessments were followed by increased cortisol levels and decreased growth hormone levels. To alleviate stress, various interventions were tried including caregiver comforting techniques and giving the neonates opportunities to comfort themselves by sucking on pacifiers. The caregiver intervention studies revealed that (a) a simple placement of hands on the head and abdomen of the NICU neonate resulted in a lesser need for oxygen and (b) massaging the NICU neonate resulted in greater weight gain and earlier discharge. In those studies that explored the infant's self-comforting, nonnutritive sucking behavior, the following results emerged: (a) sucking on pacifiers during heelsticks resulted in less crying and lower heart rate and respiration and (b) sucking on pacifiers during tube feedings resulted in smoother bottle feedings later and in greater weight gain. Thus, it appears that several forms of cost-effective interventions can alleviate these stressful procedures and facilitate infant growth and development.