Clinical Judgement of Comfort in Preterm Infants by Neonatal Intensive Care Unit Nurses Accurately Reflects Neonatal Stress Exposure.

Objective: We aimed to investigate whether there was a correlation between the clinical judgement of comfort by neonatal intensive care unit (NICU) nurses and the daily stress exposure in the first 28 days of life in extremely to very preterm infants born before 30 weeks' gestation. Study Design: We included 45 infants born <30 weeks' gestation and/or <1,000 g of birth weight in an observational cohort study. Nurses' clinical judgement of comfort was based on a 10-point numeric rating scale. We quantified exposure to neonatal stress using the Neonatal Infant Stressor Scale. We calculated Spearman's correlation coefficients to determine the strength of the association between the two for each day between birth and 28 days of life. Results: Average clinical judgement scores ranged from 4 to 10, with means mainly between 7 and 8. Days 1 to 3 were excluded because of missing data. For days 4 to 20, we found moderate to high correlation coefficients. After day 21, we did not identify significant correlations anymore, possibly due to less variance in data. Conclusion: Clinical judgment of comfort in preterm infants by NICU nurses adequately reflects neonatal stress exposure. Our findings call for more research into the best measure of neonatal stress that encompasses both exposure to stressors and experience of stress. Key Points: · Measuring neonatal stress is difficult, and exposure may not be the same as experience.. · NICU nurses' judgement of stress and comfort accurately reflects exposure to stress.. · Exposure to stress and experience of stress are therefore related.. · Future studies should focus on creating a gold standard for measuring neonatal stress..