Evidence map›Paper›PMID 21976396›Full record

ArticleAnnals of neurology2011

Neonatal intensive care unit stress is associated with brain development in preterm infants.

Gillian C Smith, Jordan Gutovich, Christopher Smyser, Roberta Pineda, Carol Newnham, Tiong H Tjoeng, Claudine Vavasseur, Michael Wallendorf, Jeffrey Neil, Terrie Inder

2 registry-linked trialsAbstract read
In one paragraph

Article in Annals of neurology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 209 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
209citing papers in PubMed, 8 pooled it
40.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03316547 nacompletednot on this mapstarted 2017, after this paper: background citation

Supporting and Enhancing NICU Sensory Experiences to Optimize Developmental Outcomes in Preterm Infants

TypeinterventionalSponsorWashington University School of MedicineRan2017 to 2019Enrolled70ConditionsPremature Birth of NewbornArmsSENSE Program
NCT05711927 nacompletednot on this mapstarted 2023, after this paper: background citation

The Effect of Sleeping Environment on Sleep-Wake Organization in Preterm Infants

TypeinterventionalSponsorColumbia UniversityRan2023 to 2025Enrolled20ConditionsPrematurity, Very Preterm Maturity of InfantArmsSNOO Smart Sleeper, Traditional bassinet
3 · Its place in the literature

Who cites it

209 citing papers in PubMed, 8 syntheses or guidelines pooled it, 536 citations in OpenAlex.

  1. Sucrose or glucose compared to breast milk for pain control in preterm infants: a systematic review and meta-analysis.Journal of perinatology : official journal of the California Perinatal Association · 2025
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  13. Sucrose vs. skin to skin care for preterm neonatal pain control-a randomized control trial.Journal of perinatology : official journal of the California Perinatal Association · 2018
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  15. Cerebral Lateralization is Protective in the Very Prematurely Born.Cerebral cortex (New York, N.Y. : 1991) · 2015
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149 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 2 countries.

Gillian C SmithDepartment of Pediatrics, Washington University School of Medicine, 660 South Euclid Ave., St Louis, MO 63110, USA.
Jordan Gutovich
Christopher Smyser
Roberta Pineda
Carol Newnham
Tiong H Tjoeng
Claudine Vavasseur
Michael Wallendorf
Jeffrey Neil
Terrie Inder
Washington University in St. Louis · USParenting Research Centre · AU

Funding

Washington University Institute of Clinical and Translational Sciences (UL1)UL1RR024992 · NCRR · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2007 to 2011
$45.4M
NEUROLOGICAL SCIENCES ACADEMIC DEVELOPMENT AWARD(INST)K12NS001690 · NINDS · WASHINGTON UNIVERSITY · PI WONG, MICHAEL · 1993 to 2018
$5.2M
Washington University Institute of Clinical and Translational Sciences (TL1)TL1RR024995 · NCRR · WASHINGTON UNIVERSITY · PI EVANOFF, BRADLEY A · 2007 to 2011
$2.3M
OPTICAL IMAGING OF BRAIN FUNCTION IN THE PRETERM INFANTR21HD057512 · NICHD · WASHINGTON UNIVERSITY · PI CULVER, JOSEPH P · 2008 to 2009
$418k
NCRR NIH HHS TL1 RR024995NCRR NIH HHS UL1 RR024992NICHD NIH HHS HD057512NICHD NIH HHS R21 HD057512
6 · The paper itself

Abstract

objectiveAlthough many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner.

methodsIn this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations.

resultsExposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination.

interpretationExposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted.

Indexed as

Intensive Care Units, NeonatalMagnetic Resonance ImagingBrainDevelopmental DisabilitiesFemaleHumansInfant BehaviorInfant, NewbornInfant, PrematureMalePregnancyProspective StudiesRisk Factors

Identifiers

PMID21976396
PMCPMC4627473
OpenAlexW2010100154

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.