J Perinat Neonat Nurs Vol. 23, No. 4, pp. 363–371 Copyright c  2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Relationships Between Environmental Stressors and Stress Biobehavioral Responses of Preterm Infants in NICU Niang-Huei Peng, PhD, RN; Jean Bachman, DSN, RN; Ruth Jenkins, PhD, RN; Chao-Huei Chen, MD; Yue-Cune Chang, PhD; Yu-Shan Chang, BSN, RN; Teh-Ming Wang, MD Although research has demonstrated that the neonatal intensive care unit (NICU) is a stressful environment for preterm and high-risk infants, little research validates the suspected relationships between infant biobehavioral responses and environmental stress in the NICU. This exploratory study examined the relationship between environmental stress and biobehavioral responses of preterm infants. The study used a repeated-measures research design to examine research variables in one group of preterm infants. Measurements of research variables were recorded every 2 minutes during two 60-minute observation periods for each research day (1 hour in the morning and 1 hour in the afternoon) and conducted over 2 days. A convenience sample of 37 preterm infants was recruited from 2 medical centers in Taiwan. A total of 4164 observations were made and recorded during the study. There was a statistically significant ( P < .05) relationship between environmental stressors and changes in physiological signals. There were also statistically significant ( P < .05) relationships between environmental stress and some specific stress behaviors. This research is applicable to neonatal clinical practice because it demonstrates the importance of recognizing the preterm infant’s biological stress responses to environmental stressors, allowing for early interventions to reduce the possibility of more serious physiological or pathological changes in the status of the preterm infant. Key words: environmental stress , preterm infant , stress behavioral responses , stress physiological signals Author Affiliations: Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan (Dr Peng); College of Nursing, University of Missouri, St Louis (Drs Bachman and Jenkins); Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan (Dr Chen and Ms Wang); Department of Mathematics, Tmkang University, Tamsui, Taiwan (ROC) (Dr Chang); and Children Hospital, China Medical University, Taichung, Taiwan (ROC) (Ms Chang). The authors thank Dr Victor Battistich for his many contributions to our research. His death was our great loss and would like to dedicate this research report to him. Corresponding Author: Niang-Huei Peng, PhD, RN, Department of Nursing, Central Taiwan University of Science and Technology, No 11, Pu-Tzu Lane, Pu-tzu District, Taichung city 406, Taiwan (Republic of China) (gingerlily.peng@gmail.com) Submitted for publication: August 25, 2008 Accepted for publication: August 24, 2009 T he neonatal intensive care unit (NICU) provides treatments for maintaining the vital functions of preterm infants because of immaturity of all major body systems, especially the nervous system. 1 How- ever, some researchers 2–4 have pointed out that the NICU environment involves sensory overload and is a mismatch to the requirements of the developing nervous system in preterm infants. In order to not only assure survival but also foster the development of preterm infants, it is critical to understand the interac- tion among the environment and the function and pro- gression of preterm infants. In addition, there is little research validating the suspected relationships be- tween the environmental stress and infant biobe- havioral responses in NICUs. 5 Additional research 363