Psychological and hormonal indicators of stress (serum cortisol and prolactin) in mothers of preterm newborns admitted to a neonatal intensive care unit
DOI:
https://doi.org/10.24265/%20horizmed.2025.v25n2.05Keywords:
Stress, Psychological , Hydrocortisone , Prolactin , Infant, Premature , Intensive Care Units, NeonatalAbstract
Objective: To evaluate variations in psychological stress, as well as cortisol and prolactin (PRL) levels, in mothers of preterm newborns (NBs) by examining the changes between the initial days of their child’s admission to a neonatal intensive care unit (NICU) and the time prior to hospital discharge. Materials and methods: A quantitative study using a non-experimental, cross-sectional, descriptive survey design with a comparative approach. The sample consisted of 35 mothers of preterm NBs, selected through purposive sampling. The inclusion criteria required that infants be hospitalized in an NICU due to prematurity (< 1500 g birth weight and < 32 weeks of gestation) and that mothers attend the breastfeeding center (BC) to express milk to support breastfeeding. Mothers with a history of psychiatric disorders, as reported during pre-study interviews, were excluded. Results: Markedly higher levels of psychological stress were observed upon admission to the NICU in relation to aspects and sounds of the unit, the infant’s appearance and behavior, the mother-child relationship and the parent’s role. These stress levels decreased prior to hospital discharge. No significant differences were found in communication with the healthcare team. Cortisol levels notably increased between the two time points, peaking prior to discharge. No significant differences were observed in prolactin levels. Conclusions: Psychological stress decreases as discharge approaches, whereas cortisol levels increase, indicating a persistent physiological response. Monitoring stress levels over time is essential for identifying critical moments. Simultaneous assessment of psychological stress and hormone levels provides a more comprehensive follow-up of maternal progress and the effectiveness of interventions, facilitating timely adjustments in support and treatment strategies.
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References
Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L,
Lewin A, et al. National, regional, and worldwide estimates of preterm
birth in 2020, with trends from 2010: a systematic analysis. Lancet
[Internet]. 2023;402(10409):1261-71. Disponible en: https://www.
thelancet.com/journals/lancet/article/PIIS0140-6736(23)00878-4/
fulltext
Perin J, Mulick A, Yeung D, Villavicencio F, López G, Stron KL, et al.
Global, regional, and national causes of under-5 mortality in 2000-19:
an updated systematic analysis with implications for the Sustainable
Development Goals. Lancet Child Adolesc Health [Internet].
;6(2):106-15. Disponible en: https://doi.org/10.1016/S2352-
(21)00311-4
Brockington I. Postpartum psychiatric disorders. Lancet [Internet].
;363(9405):303–10. Disponible en: https://doi.org/10.1016/
S0140-6736(03)15390-1
Parfitt Y, Ayers S. The effect of postnatal symptoms of post-traumatic
stress and depression on the couple’s relationship and parentbaby
bond. J Reprod Infant Psychol [Internet]. 2009;27(2):127-42.
Disponible en: https://doi.org/10.1080/02646830802350831
Stein A, Pearson R, Goodman S, Rapa E, Rahman A, McCallum M,
et al. Effects of perinatal mental disorders on the fetus and child.
Lancet [Internet]. 2014;384(9956):1800-19. Disponible en: https://
doi.org/10.1016/S0140-6736(14)61277-0
Ruiz A, Ceriani-Cernadas LM, Cravedi V, Rodríguez D. Estrés y
depresión en madres de prematuros: un programa de intervención.
Arch Argent Pediatric [Internet]. 2005;103(1):36-45. Disponible en:
http://www.scielo.org.ar/pdf/aap/v103n1/v103n1a08.pdf
Wormald F, Tapia JL, Torres G, Cánepa P, González MA, Rodríguez D, et
al. Estrés en padres de recién nacidos prematuros de muy bajo peso
hospitalizados en unidades de cuidados intensivos neonatales. Estudio
multicéntrico. Arch Argent Pediatric [Internet]. 2015;113(4):303-9.
Disponible en: https://doi.org/10.5546/aap.2015.303
Torrecilla NM Nacimiento prematuro: Evaluación del estrés materno
y su relación con el vínculo temprano y lactancia materna durante
el período de internación. Tesis para optar al título de Doctora en
Psicología. Facultad de Ciencias Humanas. Universidad Nacional de
San Luis. San Luis. Argentina. 2011.
Giraldo MDI, Lopera MFA, Duque DY, Londoño GA, Gaviria MC,
Restrepo GÁ, et al. Estrés y factores relacionados en padres
con hijos en la Unidad de Cuidado Intensivo Neonatal. Horiz
Enferm [Internet]. 2012;23(3):13-22. Disponible en: https://
revistaingenieriaconstruccion.uc.cl/index.php/RHE/article/
view/12084
Peña Silva B, García Araya A, Miranda Iglesias M, Caviedes Fernández
J, Ulloa Ramírez V, Rementería Rementería Y. Estrés parental y sus
dimensiones en Unidades de Cuidado Intensivo Neonatal – Pediátrica:
Revisión Narrativa. ACC CIETNA [Internet]. 2012;8(2):67-84.
Disponible en: https://doi.org/10.35383/cietna.v8i2.611
Acosta M, Cabrera N. Percepción de padres de hijos prematuros
frente a la hospitalización en la Unidad de Cuidado Intensivo
Neonatal: un estudio de revisión documental. Rev UNIMAR [Internet].
;34(1):193-9. Disponible en: https://revistas.umariana.edu.co/
index.php/unimar/article/view/1144/pdf
González-Escobar DS, Ballesteros-Celis NE, Serrano-Reatiga MF.
Determinantes estresores presentes en madres de neonatos
pretérmino hospitalizados en las Unidades de Cuidados Intensivos.
Rev Cienc Cuidad [Internet]. 2012;9(1):43-53. Disponible en: https://
dialnet.unirioja.es/servlet/articulo?codigo=3986747
Balbino FS, Balieiro MMFG, Mandetta MA. Measurement of familycentered
care perception and parental stress in a neonatal unit. Rev
Lat-Am Enferm [Internet]. 2016;24:e2753. Disponible en: https://
doi.org/10.1590/1518-8345.0710.2753
Cox DB, Kent JC, Casey TM, Owen s RA, Hartmann PE. Breast
growth and urinary excretion of lactose during human pregnancy
and early lactation: Endocrine relationships. Exp Physiol [Internet].
;84(2):421-34. Disponible en: https://doi.org/10.1111/j.1469-
X.1999.01807.x
Neville MC. Anatomy and Physiology of Lactation. Pediatr Clin
North Am [Internet]. 2001;48(1):13-34. Disponible en: https://doi.
org/10.1016/S0031-3955(05)70283-2
Hernández Sampieri R, Fernández Collado C, Baptista Lucio P.
Metodología de la Investigación (6° edición) 2014. McGrawHill.
Miles MS, Funk SG, Carlson J. Parental Stressor Scale: Neonatal
Intensive Care Unit. Nur Res [Internet]. 1993;42(3):148-52. Disponible
en: https://pubmed.ncbi.nlm.nih.gov/8506163/
Caruso A. Evaluación psicológica del estrés en padres de bebés
prematuros internados en la Unidad de Cuidados Intensivos
Neonatológicos (UCIN). La adaptación de la Escala de Estrés Parental:
Unidad de Cuidados Intensivos Neonatológicos (PSS: NICU). En: II
Congreso Internacional de Investigación y Práctica Profesional en
Psicología: 22, 23 y 24 de noviembre de 2010. Facultad de Psicología -
Universidad de Buenos Aires, Buenos Aires, 2010. p. 437-9.
Ley Nacional de Protección de Datos Personales n°25.326.
Disponible en: https://boletinoficial.buenosaires.gob.ar/
normativaba/norma/88070#:~:text=S%C3%ADntesis%3A,01%20DEL%20
PODER%20EJECUTIVO%20NACIONAL.
Miles MS, Funk SG, Kasper MA. The neonatal intensive care unit
environment: sources of stress for parents. AACN Clin Issues Crit
Care Nurs [Internet]. 1991;2(2):346-54. Disponible en: https://doi.
org/10.4037/15597768-1991-2022
Smith J, Swallow V, Coyne I. Involving parents in managing their
child’s long-term condition—a concept synthesis of family-centered
care and partnership-in-care. J Pediatr Nurs [Internet]. [Internet].
;30(1):143-59. Disponible en: https://doi.org/10.1016/j.
pedn.2014.10.014
Galarza-Winton ME, Dicky T, O’Leary L, Lee SK, O’Brien K.
Implementing family-integrated care in the NICU: educating nurses.
Adv Neonat Care [Internet]. 2013;13(5):335-40. Disponible en:
https://doi.org/10.1097/ANC.0b013e3182a14cde
Bracht M, O’Leary L, Lee SK, O’Brien K. Implementing familyintegrated
care in the NICU: a parent education and support program.
Adv Neonat Care [Internet]. 2013;13(2):115-26. Disponible en:
https://doi.org/10.1097/ANC.0b013e318285fb5b
Guber HA, Farag AF. Evaluation of endocrine function. In: McPherson
RA, Pincus MR, eds. Henry’s clinical diagnosis and management by
laboratory methods. Chap 24th 22nd ed. Philadelphia: Elsevier
Saunders; 2011. p.365-401
Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S,
Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook
of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020: chap 15
Forde D, Lin Fang M, Miaskowski C. A systematic review of the effects
of skin-to-skin contact on biomarkers of stress in preterm infants and
parents. Adv Neonat Care [Internet]. 2022;22(3):223–30. Disponible
en: https://doi.org/10.1097/ANC.0000000000000905
Habersaat S, Borghini A, Nessi J, Pierrehumbert B, Forcada-Guex
M, Ansermet F, et al. Posttraumatic stress symptoms and cortisol
regulation in mothers of very preterm infants. Stress Health [Internet].
;30(2):134-41. Disponible en: https://doi.org/10.1002/smi.2503
Thompson LA, Trevathan WR. Cortisol reactivity, maternal sensitivity,
and infant preference for mother’s familiar face and rhyme in 6-monthold
infants. J Reprod Infant Psychol [Internet]. 2009;27(2):143–
Disponible en: https://doi.org/10.1080/02646830801918463
Welberg LAM, Seckl JR. Prenatal stress, glucocorticoids and
the programming of the brain. J. Neuroendocrinol [Internet].
;13(2):113–28. Disponible en: https://doi.org/10.1111/j.1365-
2001.00601.x
De Weerth C, Buitelaar JK. Physiological stress reactivity in human
pregnancy: a review. Neuroscience & Biobehavioral Rev [Internet].
;29(2):295–312. Disponible en: https://doi.org/10.1016/j.
neubiorev.2004.10.005
Brunton PJ, Russell JA. Attenuated hypothalamo-pituitaryadrenal
axis responses to immune challenge during pregnancy: the
neurosteroid opioid connection. J Physiol [Internet]. 2008;586(2):369-
Disponible en: https://doi.org/10.1113/jphysiol.2007.146233
David A, Neumann D. No stress please! Mechanisms of stress
hyporesponsiveness of the maternal brain. J Physiol [Internet].
;586(2):377–85. Disponible en: https://doi.org/10.1113/
jphysiol.2007.145896
Brunton PJ, Russell JA, Douglas AJ. Adaptive responses of the maternal
hypothalamic-pituitary-adrenal axis during pregnancy and lactation.
J Neuroendocrinol [Internet]. 2008;20(6):764-76. Disponible en:
https://doi.org/10.1111/j.1365-2826.2008.01735.x
Vegiopoulos A, Herzig S. Glucocorticoids, metabolism and metabolic
diseases. Mol Cell Endocrinol [Internet]. 2007;275:43–61. Disponible
en: https://doi.org/10.1016/j.mce.2007.05.015
De Kloet ER, Karst H, Joels M. Corticosteroid hormones in the central
stress response: quick-and-slow. Front Neuroendocrinol [Internet].
;29(2):268-72. Disponible en: https://doi.org/10.1016/j.
yfrne.2007.10.002
Maruyama M, Matsumoto H, Fujiwara K, Noguchi J, Kitada C, Fujino
M, et al. Prolactin-releasing peptide as a novel stress mediator in the
central nervous system. Endocrinology [Internet]. 2001;142(5):2032–
Disponible en: https://doi.org/10.1210/endo.142.5.8118
Mera T, Fujihara H, Kawasaki M, Hashimoto H, Saito T, Shibata M,
et al. Prolactin-releasing peptide is a potent mediator of stress
responses in the brain through the hypothalamic paraventricular
nucleus. Neuroscience [Internet]. 2006;141(2):1069–86. Disponible
en: https://doi.org/10.1016/j.neuroscience.2006.04.023
Villamizar-Carvajal C, Vargas-Porras JR, García-Corzo R. Disminución
del nivel de estrés en madres de prematuros en la Unidad de Cuidados
Intensivos. Enferm Intensiva [Internet]. 2018;29(3):113-20. Disponible
en: https://doi.org/10.1016/j.enfie.2017.12.003
Gallegos-Martínez J, Hernández JR, Gracinda Silvan C. El recién
nacido prematuro hospitalizado: la importancia de la participación
de los padres en la Unidad Neonatal. Rev Latino-Am. Enfermagem
[Internet]. 2013;21(6):1360-6. Disponible en: https://doi.
org/10.1590/0104-1169.2970.2375
Gooding JS, Cooper LG, Blaine AI, Franck LS, Howse JL, et al. Family
support and family-centered care in the neonatal intensive care unit:
origins, advances, impact. Semin Perinatol [Internet]. 2011;35(1):20-
Disponible en: https://doi.org/10.1053/j.semperi.2010.10.004
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