METHODOLOGICAL ISSUES IN PRETERM INFANT OUTCOMES

This study will investigate methodological issues in preterm infant
outcomes by applying time series techniques to the analysis of
longitudinal data collected in the NICU environment and integrating these
single subject results for generalization across individuals. These
methodological and analytic techniques will help elucidate the biologic,
behavioral, and growth processes of preterm infants and will suggest
potential intervention strategies for ameliorating the outcomes of these
infants. The five specific aims outlined are to: 1) identify and describe
both short- and long-term biobehavioral VLBW and/or VP infant outcomes as
they vary over time; 2) describe salient aspects of the NICU micro-
environment as they vary over time; 3) investigate the dynamic
relationships between biobehavioral VLBW and/or VP infant outcomes and the
NICU micro-environment over time; 4) describe the relationships between
the characteristics and demographics of VLBW and/or VP infants, parental
participation in their infants' care, and infants' biobehavioral outcomes;
and 5) interpret the above findings in terms of an eco-technology
approach, identifying specific ways in which variations in environmental
care might facilitate positive health care outcomes and disease
prevention. Sixty-eight preterms whose gestations are equal to or less
than 29 wk will be studied from admission until they are 30 wk gestation,
or are transferred or discharged. The study variables include gestational
age, growth measures, severity of illness, demographics, skin temperature,
heart rate, respiratory rate, mean umbilical arterial pressure (for those
infants with umbilical arterial lines), oxygen saturation, peripheral
blood pressure, behavior as assessed using the Neonatal Individualized
Developmental Care and Assessment Program (NIDCAP; Als & Gibes, 1984),
pre- and post-NlDCAP salivary cortisol levels, a contextual measurement of
the NICU environment, light and sound intensities, sound frequencies,
isolette and warmer bed temperatures, and NICU bedspace geography. These
variables will be obtained at pre-determined times for each infant. In
addition, data pertinent to family visitation will be collected using a
daily survey log. At the completion of the study and the infant's
hospitalization, the costs of stay during the study period and for the
entire hospitalization will be collected from patient accounting. Data
will be analyzed using time series analysis to determine how the current
NICU environment relates to VLBW and VP infant biologic status, behavior,
growth, and parental visitation dynamically. Specific ways, areas, times,
and settings, in which variations in treatment might facilitate early
problem treatment and/or early problem detection will be suggested and
refined using consultation from a neonatologist. The results from this
normative research study will be critical for comparing the effects of any
changes implemented in neonatal nursing on behalf of optimizing infant
growth, development, and well-being in subsequent studies.