Informed medical trauma and toxic stress in intensive neonatology

The neonatal period and the first years of life are a critical and sensitive period of a child's development, and traumatic events play a decisive role in disrupting the trajectory of physical, emotional, and behavioral development. Аim - to highlight current views on the neurobiology of stress and features of medical trauma in intensive neonatology from the point of view of possible epigenetic influences on the trajectory of child's development. The definition of trauma-informed medical care, so as concepts of neonatal allostasis, allostatic load and toxic stress were considered. Critical components of neonatal model of medical trauma are separation from parents, untreated or undiagnosed pain, and excessive allostatic load. In NICU setting, organizing family-centered care from the point of TIMC’s view must be reviewed as a philosophy that benefits the entire family, not just the child. The consequences of the modifying cumulative effect of intensive treatment on the nervous system development are considered, with discussion of mechanisms of the unique plasticity of brain during critical periods in newborns and infants. Three main brain structures and their contribution to the formation of stress response are presented. The structural and functional consequences of toxic stress and the level of disorganization of the developing brain architecture are adduced. The way to overcome medical trauma in neonatology is biobehavioral synchrony between parents and newborn, which supports the constant regulation of allostasis, prevents the development of allostatic load into toxic stress with violation of plastic brain architecture. The pathology of the newborn is also an important risk factor for perinatal post-traumatic stress disorder in parents after infant's staying in NICU, which requires its timely detection and correction. Organization of neonatal care in terms of FFC and informed medical trauma is a preventive way of epigenetic influences on the child's developmental trajectory. Partnership between families and staff has high potential for obtaining information about the nature and source of medical trauma in newborns, as well as for systemic transformation of intensive care neonatology. No conflict of interest was declared by the authors.