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Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN)

A Proposed Concept for Science and Practice

D'Agata, Amy L. PhD, MS, RN; Young, Erin E. PhD; Cong, Xiaomei PhD, RN; Grasso, Damion J. PhD; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN

Section Editor(s): Forsythe, Paula L.

doi: 10.1097/ANC.0000000000000309
Outcomes of Neonatal Care

Background: Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes.

Purpose: This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience.

Implications for Practice and Research: Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.

School of Nursing, University of Connecticut, Storrs (Drs D'Agata, Young, Cong, and McGrath); Connecticut Children's Medical Center, Hartford (Dr McGrath); School of Medicine, University of Connecticut, Farmington (Drs Young and Grasso); and College of Nursing, University of South Florida, Tampa (Dr D'Agata).

Correspondence: Amy L. D'Agata, PhD, MS, RN, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612 (

Jacqueline M. McGrath, PhD, RN, FNAP, FAAN who is Co-editor of Advances in Neonatal Care, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by another member of the editorial team for the journal. The remaining authors declare no conflicts of interest.

© 2016 by The National Association of Neonatal Nurses