Abstract

The purpose of this study was to evaluate the predictive validity of the NISS by examining associations between NISS scores and neurodevelopmental outcomes at 3 months corrected gestational age (CGA) using the Test of Infant Motor Performance (TIMP). We also examined whether these associations vary by gestational age (GA) at the time of assessment and illness severity.

The study was conducted in a large level IV Neonatal Network in the Midwest.

This was a non-experimental, longitudinal cohort study to determine the predictive validity of the NISS in relation to neurodevelopmental outcomes in preterm infants. This study was conducted as part of a larger study (hereafter referred to as the parent study) designed to identify barriers and facilitators of parent presence in the NICU and of parent participation in caregiving, and to examine the effects of presence and participation on infant neurodevelopment. Building on the parent study, this study evaluated the predictive validity of the NISS by examining the association between mean NISS scores during the first 28 days of life and early neurodevelopmental outcomes in preterm infants.

Mean gestational age at birth was 28.3 weeks, and birth weight was 1213.5g. Total NISS scores did not significantly predict TIMP scores after controlling for illness severity and age at assessment (β = -.005, p = .41). Peak illness severity (NIS) was significantly associated with lower TIMP scores (β=-.812, p=.02), although age at assessment was not a significant predictor.

Future research should examine caregiving stress in real time and consider contextual factors like developmental care, parental presence, and prior stress exposure. Longer-term neurodevelopmental outcomes may also better identify potential effects of early stress exposure that are not yet apparent at 3 months corrected age.

Cumulative nurse caregiving-related stress, measured by the NISS, was not associated with neurodevelopment at 3 months corrected age after accounting for illness severity and age at assessment. However, greater peak illness severity was associated with poorer neurodevelopment. These findings suggest that early neurodevelopment may be more strongly affected by illness severity than by cumulative caregiver stress measured by the NISS.

Notes

Funding Acknowledgement: Dr. Cistone is a recipient of a 2025 Sigma/Midwest Nursing Research Society Research Grant

Author Details

Nicole Cistone, PhD, RN

Sigma Membership

Epsilon

Type

Report

Format Type

Text-based Document

Study Design/Type

Longitudinal Study

Research Approach

Quantitative Research

Keywords:

Preterm Infants, Premature Infants, Nurse Caregiving Stress, Physiological Stress, Neonatal Intensive Care, Neonatal Intensive Care Units, Neurodevelopment, Neural Development

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Sigma Grant Recipient Report

Acquisition

Proxy-submission

Date of Issue

2026-10-12

Full Text of Presentation

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Funder

Sigma Foundation for Nursing

Second Funder

Midwest Nursing Research Society

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Available for download on Wednesday, April 12, 2028

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