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Preterm Stress Behaviors, Autonomic Indices, and Maternal Perceptions of Infant Colic

Gardner, Fumiyuki, C., PhD; Adkins, Cherie, S., PhD, RN; Hart, Sarah, E., MD; Travagli, R., Alberto, PhD; Doheny, Kim, Kopenhaver, PhD, NNP-BC

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000451
Original Research

Background: While biological and behavioral stress response systems are intact in early gestation, preterm infants' behaviors are often more subtle and difficult to interpret compared with full-term infants. They are also more vulnerable for regulatory issues (ie, colic) that are known to impact caregiver–infant interactions. Biobehavioral measures such as behavioral responsivity and heart rate variability (HRV), particularly cardiac vagal tone, may help elucidate preterm infants' stress/regulatory systems.

Purpose: To test the hypotheses that preterm infants' consoling behaviors and high-frequency (HF) HRV in the first week of life are significantly associated and they are inverse correlates of future colic risk.

Methods/Search Strategy: Thirty preterm (mean ± SE = 32.7 ± 0.3 weeks postmenstrual age [PMA]) infants underwent direct NIDCAP (Newborn Individualized Development and Assessment Program) observation during routine care and had HRV measurements during their first week postbirth. Sixty-three percent of mothers completed the Infant Colic Scale at 6 to 8 weeks adjusted postnatal age. Nonparametric tests were used to determine associations among behaviors, HRV, and maternal perceptions of infant colic.

Findings/Results: Self-consoling behaviors were positively associated with HF-HRV (vagal tone). In addition, stress behaviors were positively associated with low-frequency/high-frequency HRV (sympathetic dominance). Infants who displayed more stress behaviors also demonstrated more self-consoling behaviors. No significant associations were found with colic.

Implications for Practice: HF-HRV provides information on the infant's capacity to modulate stress and is a useful, noninvasive measure when behaviors are more difficult to discern.

Implications for Research: Further study in a larger sample is needed to determine whether behavioral stress measures and HF-HRV may be useful to determine colic risk.

Penn State Hershey Children's Hospital and Department of Pediatrics, Penn State Hershey, College of Medicine, Hershey, Pennsylvania (Drs Gardner and Doheny); Stabler Department of Nursing, York College of Pennsylvania, York (Dr Adkins); Department of Anesthesia, Critical Care and Pain Management, Deaconess Medical Center, Boston, Massachusetts (Dr Hart); and Department of Neural and Behavioral Sciences, Penn State Hershey, College of Medicine, Hershey, Pennsylvania (Drs Travagli and Doheny).

Correspondence: Kim Kopenhaver Doheny, PhD, NNP-BC, Division of Newborn Medicine, Department of Neural and Behavioral Sciences, Penn State Hershey, College of Medicine, PO Box 850, Hershey, PA 17033 (

Institution of the Study: Penn State Health Children's Hospital, level IV-C NICU.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

This study was supported in part by a research grant from the Children's Miracle Network (K.K.D.) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under award number 1R01DK099350 (R.A.T., K.K.D.). The authors are thankful to the neonatal staff of their unit for assistance in the recruitment of eligible subjects and for the excellent care they provide to their patients. In addition, the authors are grateful to the parents who consented for their infants to participate and mothers who completed the colic survey.

None of the funding sources had any role in the design of the study, in the analysis and interpretation of the data, in the decision to submit the manuscript, or in the preparation, review, or approval of the manuscript.

© 2018 by The National Association of Neonatal Nurses