All the juicy stuff is always near the end of these things.
“Premature exposure to physical sensations (e.g., light, sound, and handling), mechanical monitors, and painful, sometimes tissue-damaging treatments are stressful for preterm infants. […]
In infants born too early— before the rise in fetal cortisol levels in late gestation, the hypothalamic-pituitary-adrenal axis, is likely to be still in a suppressed state, resulting in adrenal insufficiency, whereby the amount of cortisol produced in response to a stressor is too little to maintain homeostasis.
The ability to mount an effective cortisol response to stressors
when it is needed is essential for survival, and adrenal insufficiency exposes preterm neonates to heightened risk of both short-term and long-term consequences of stress.
Moreover, endocrine set points may be altered in
children born extremely preterm.