{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:51:53Z","timestamp":1783443113232,"version":"3.54.6"},"reference-count":56,"publisher":"Springer Publishing Company","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neonatal Network"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:p>Premature infants admitted to the NICU often require intravenous (IV) therapy. Peripheral intravenous catheter (PIVC) insertion is a common painful\/stressful\/invasive procedure. Repeated exposure to stressors produces toxic stress: a prolonged, frequent activation of the body\u2019s stress response that occurs when buffering relationships, that is, mother\/supportive adult, are absent. This article presents an exemplar case study of a PIVC insertion to describe toxic stress responses a premature infant experienced during the procedure. The infant was admitted for extreme prematurity and respiratory failure. Twenty-nine days later, the infant developed possible necrotizing enterocolitis that necessitated cessation of enteral feedings, gastric decompression, IV administration of fluids, parenteral nutrients, and antibiotics. The PIVC insertion procedure was monitored and observed. The infant showed physiologic dysregulation, including bradycardia, tachycardia, oxygen desaturation, and high skin conductance responses, resulting from the stress exposure and insufficient nonpharmacologic\/pharmacologic stress interventions. Education and practice change are needed to promote pain\/stress management.<\/jats:p>","DOI":"10.1891\/nn-2024-0008","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T14:35:17Z","timestamp":1729521317000},"page":"275-285","source":"Crossref","is-referenced-by-count":2,"title":["Multiple Attempts of Peripheral Intravenous Catheter Insertion in a Preterm Infant Provoke Toxic Stress: A Case Report"],"prefix":"10.1891","volume":"43","author":[{"given":"Hind B.","family":"Alsabti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Ludington-Hoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ann","family":"Blatz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie Boebel","family":"Toly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"793","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"2024102204000924000_43.5.275.1","doi-asserted-by":"crossref","unstructured":"Crist\u00f3bal Ca\u00f1adas D , Bonillo Perales A , Galera Mart\u00ednez R , Casado-Belmonte MDP , Parr\u00f3n Carre\u00f1o T . 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