Scoping Review of Early Toxic Stress and Epigenetic Alterations in the Neonatal Intensive Care Unit.
Kathryn J Malin, Kaboni W Gondwe, Alissa V Fial and 4 others
PMID 37084322WHAT IT FOUND
Thirteen NICU studies associated higher pain or toxic stress exposure with increased SLC6A4 methylation changes and associated those changes with later attention and social-emotional problems.
No study used a valid NICU stress measure, so causality is not proven.
Key findings
01Higher NICU stress or pain exposure was associated with increased SLC6A4 DNA methylation at discharge.
02Increased SLC6A4 DNA methylation was associated with later attention, social-emotional, and anger response problems.
03No included study used a valid and reliable instrument to measure stress in the NICU.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 13 articles were included, and five of them used the same data set. Studies measured stress and outcomes at different times, from birth to 7 years, and used different instruments. No included study used a valid and reliable instrument to measure stress in the NICU. The search was limited to English-language studies, so relevant studies may have been missed. The review cannot separate the effects of NICU stress from prematurity and developmental changes. Only DNA methylation was reviewed, not other epigenetic mechanisms.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not read these associations as proof that NICU stress causes epigenetic changes or that reducing stress will improve neurodevelopment. The review mapped inconsistent observational findings, and no study used a valid and reliable NICU stress instrument.