published_or_final_version / abstract / toc / Speech and Hearing Sciences / Master / Master of Science in Audiology

Sepsis is a devastating, life-threatening disease and a major problem for many newborns; it develops rapidly and requires expertise to identify the early, subtle signs to prevent death or disability. Evidence from nursing practice and philosophic inquiry indicates that nurses use diverse ways of knowing in their assessments. The purpose of this research was to address research questions concerning two areas: 1) Neonatal Intensive Care Unit (NICU) nurses’ patterns of knowing in the assessment of infants with sepsis as related to dimensions of nursing practice; and 2) Test the psychometric properties of the Newborn Scale of Sepsis (SOS) as a diagnostic or assessment tool. The theoretical framework incorporated the epistemological theories of nurses Carper and Benner and philosopher of science Nagel. This study employed a prospective, correlational design with a convenience sample of 119 NICU nurses. Twenty-eight of these nurses also completed the Newborn SOS to document their assessments of 62 newborns for sepsis. Two instruments were used: 1) The 16-item norm-referenced Nursing Patterns of Knowing (POK) scale (ɑ = .82 and item-scale correlations ≥ 0.33), and 2) The 13-item Newborn Scale of Sepsis (SOS), developed to assist the novice nurse to assess for signs of sepsis (ɑ = .65 and interrater reliability of 96.3%). Descriptive, psychometric, and correlational analyses were applied to the research questions. Results indicated that the more clinically experienced NICU nurses used a more integrated pattern of knowing when assessing newborns for signs of sepsis. The more experienced and competent nurses incorporated empirical, aesthetic and personal knowing in their assessments. More experienced nurses also used less authority-based knowing. More diversity in work experiences was negatively correlated with the sociopolitical pattern of knowing. Psychometric properties of the Newborn SOS indicated that, while its sensitivity was very good, its low specificity limited its usefulness as a diagnostic tool. It was concluded that the Newborn SOS can be used to assist novice nurses in developing pattern recognition of newborn sepsis. The Nursing POK has strong potential for use in a wide variety of studies examining nursing patterns of knowing in assessment of critical health conditions.

Despite considerable evidence in older populations that food intake can improve mental performance, little is known about the acute effects of feeding on cognition in the newborn period, a time when learning and memory are critical for discovering and adapting to everyday experiences. Feeding occurs well over 2500 times in the first year of life, raising the possibility that iterative effects on cognition may have cumulative effects over time. We recently demonstrated feeding enhancement of memory in two-to-three day old infants. Infants tested after a feed (versus before) displayed better memory for unfamiliar spoken words they previously habituated to and that were represented after a 100s delay. In this Doctoral Thesis, Studies 1 and 2 explore further the influence of feeding on short-term retention of spoken words. Memory was assessed using headturning and the Habituation-Recovery response. Study 1 extended the effect to older infants aged two-to-three weeks. Memory was enhanced after a feed over even longer delays, including 100s, 200s, 300s, 400s, and 500s. The overall gain in memory as measured by prefeed and postfeed differences at each delay was over two minutes long. Because newborn infants are more likely to hear recurrent words spoken by familiar voices, auditory experiences that they preferentially recognize, Study 2 looked at the separate effects of familiarity and feeding. Two day-old infants were assessed for either familiar speech-sound ("baby" spoken by the mother) or unfamiliar speech-sound from Study 1 ("beagle" spoken by a female stranger). The baby-mother sound stimulus was remembered better over a retention interval of 85 seconds than unfamiliar beagle-stranger, suggesting a strong influence of familiarity. To define the extent of the feeding effect, Study 3 examined sensorimotor processing of a reflex response. Three day-olds were assessed on habituation and retention of habituation of the glabella blink reflex over delays of 8s and l8s. No effect of feeding was found. Taken together, the implications of these findings are twofold. First, enhancement of memory for speech-sound by iterative feeding or recurrent exposure to familiar speech-sound stimuli may facilitate the acquisition of language. Second, feeding effects on cognition may depend on the nature of the task and previous experience with the stimulus. Further research is necessary for identifying what kinds of information and what processing abilities are more susceptible to the effects of feeding in early infancy.

No description available.

Our objective was to study the effect of GLN supplementation on whole body protein turnover, somatic growth and gastrointestinal tolerance to enteral feeding in neonates following surgical stress. We hypothesized that GLN in total parenteral nutrition (TPN) would (1) favor retention of lean body mass by reducing protein breakdown (PB) during the acute phase after surgery, (2) promote somatic growth, (3) decrease length of time to achieve full feeds. Protein turnover was measured in a double-blind randomized trial involving neonates admitted to the Neonatal Intensive Care Unit after major surgery. L-GLN (n = 6) was added to TPN at a dose of 200 mg/g of protein intake. Controls (n = 7) were isonitrogenous. Isotope studies were performed on Day 4 of TPN. Subjects were given a 4-hour primed constant intravenous infusion of L-[1-13C]-leucine and [15N2]-urea. In the GLN group, a 15% reduction in PB was measured (unpaired t-test, p < 0.05). There was a trend towards improved net protein balance which was statistically different from zero in the GLN group. There were no differences in somatic growth during TPN course and in the length of time to achieve full enteral feeds. Results suggest that early TPN supplemented with GLN has a beneficial sparing effect on protein metabolism in critically ill neonates after major surgical stress.

Newborn morbidity and mortality remains high despite a remarkable decline in the infant mortality and under five mortality rates in Nepal over the last decade (1996-2006). Research shows that newborns’ health outcome is associated with maternal and other factors. This study was designed to understand the factors that have an impact on three good newborn care practices: safe cord cutting, early breastfeeding and delayed bathing. The study used the interview data of 815 married women aged 15-49 years who delivered a live baby between February 2008 and February 2009, collected for the baseline survey of the Community-Based Maternal and Newborn Health program implemented in the Sindhuli district of Nepal. The mean age of the sample women was 26 years. Two-thirds of them were from disadvantaged indigenous caste/ethnicity groups, about 70% were uneducated and the majority were poor. Safe cord cutting, early breastfeeding and delayed bathing practices were studied for 803, 810 and 812 women respectively and 70.7%, 46.7%, and 16.6% of the eligible samples demonstrated the practices respectively. The logistic regression method was used to examine the association of independent factors with the outcome variables. Social gradient was found to be associated with all three practices. Rich women were more likely to demonstrate good practices and bearing a child at the prime age (20-34 years) was likely to result in safe cord cutting. Disadvantaged indigenous and ‘other’ caste/ethnicity women demonstrated unsafe cord cutting practices and dalit caste/ethnicity women demonstrated poor bathing practices. Maternal knowledge also emerged as a strong predictor of early breastfeeding and delayed bathing practices. Antenatal care from a SBA determined good breastfeeding and advice from a FCHV determined good bathing practices. The results showed that the uptake of antenatal and delivery services from a skilled birth attendant is unacceptably low in rural Nepal, which is a challenge for meeting the millennium development goals. The study recommends programmes for improving economic status as a key to improving newborn care practices. As the vast majority of the deliveries are still assisted by traditional birth attendants; including them in maternal health programmes is crucial. Increasing women’s access to a skilled birth attendant and boosting the spirit of the FCHVs to increase their efficiency is also recommended. Future research on newborn health should focus on identifying other determinants of newborn care practices and survival. Qualitative studies to understand the cultural perspectives of newborn care practices are also recommended.

No description available.

Breast fed infants appear to grow less rapidly after the first three months of age when compared with current standards from the National Center for Health Statistics (NCHS). The NCHS standards are a composite of two other studies both of which used formula fed infants or infants who were breast fed for a short period of time. Current literature suggests a breast fed infant's deviation from NCHS standards should be considered a normal pattern with no apparent deleterious consequences to a breast fed infant. This study was undertaken to determine whether differences do exist between the growth patterns of breast fed infants in Muncie, Indiana, and NCHS standards, and if so, at what age do the differences become apparent. For this study growth data were gathered for 66 infants. The subjects were women who attended the Obstetrical and Family Practice Clinics of Ball Memorial or were patients of private physicians in Muncie and Delaware County, Indiana and who volunteered to participate in the study. Women who were free of chronic conditions were elgible to participate in the study. A 24-hour data collection period was conducted one day each month for one calendar year or as long as the subjects remained in the study. Immediately before and after each nursing during the 24-hour time period weight measurements were taken and recorded for the infants. Lengths were measured once at this time. The analysis of data from this study is similar to previous studies, and showed that weight gain in particular, but also length gain, of the breast fed infant was slower after three months of age in comparison to NCHS standards and supports the recommendations of others that the weight gain of breast fed infants should not be compared to current NCHS standards and new growth charts based on breast fed infants are needed. / Department of Family and Consumer Sciences

The purpose of this study was to investigate whether multiparous mothers of full term infants perceived newborns differently than multiparous mothers of premature infants. A convenience sample of 32 multiparous mothers was selected and placed into one of two groups according to the gestational age. Group 1 was comprised of 25 full term mothers and Group 2 was comprised of 7 preterm mothers.The Neonatal Perception Inventory - I was utilized to elicit mother's perceptions of the newborn. The instrument was found to be valid and reliable for use with multiparas. Demographic data was gathered on age, educational level, number of previous pregnancies and the classification of a high-risk pregnancy.Differences between the two groups were analyzed utilizing a ttest and Analysis of Covariance. The study's results indicated that there is no significant difference between neonatal perceptions of multiparous mothers of full term infants and multiparous mothers of premature infants. / School of Nursing

I Sverige sker cirka 2500 transporter av nyfödda barn varje år. Socialstyrelsen publicerade i slutet av år 2013 en ny vägledning ”Vård av extremt tidigt födda barn”. Ett av de områden som har prioriterats är neonatala transporter. Betydelsen av en väl fungerande transportorganisation är nödvändig för att skapa en säker och jämlik vård för denna patientgrupp. Syftet med studien var att beskriva prematura och nyfödda barns påverkan av transport mellan sjukhus. Studien genomfördes som en litteraturstudie där 14 vetenskapliga artiklar analyserades. Fyra teman identifierades och besvarade frågeställningarna vad påverkar prematura och nyfödda barn under transport och hur påverkas de under transport, dessa var Höga ljudnivåer, Transportteamets kompetens, Uppvisar tecken på obehag samt Ökad risk för hjärnblödning. Genom att transportsjuksköterskan använder sig av NIDCAP kan påverkan på barnet minskas och transporten blir mindre stressande. Fler studier bör genomföras där fokus ligger på hur sjuksköterskans omvårdnadsåtgärder kan minska obehaget hos barnet under transport mellan sjukhus. / In Sweden, about 2.500 newborn infants are transportedeach year. In late 2013, the Swedish National Board of Health and Welfare (Socialstyrelsen)published a new guide, Care for Extremely Premature Babies (Vård av extremttidigt födda barn); in which one prioritized area were neonatal transports.The importance of an efficient transport organization is essential to create asafe and equal care fore these patients. The purpose of this study was todescribe the impact on preterm and newborn infants who are transported between hospitals.The study was conducted as a review of 14 academic articles. Two questions wereasked (what affects preterm and sicknewborn infants during transportation between hospitals; how are preterm and sick infant affected during transportationbetween hospitals) across four themes (High noise levels; Transport Team´s competence;Exhibition sign of discomfort; Increased risk of cerebral haemorrhage). Whenthe transport nurse uses NIDCAP, the effect on the infant may be reduced andthe transport less stressful. More studies should be conducted with a focus onhow nursing care measures can reduce anxiety to the infant during transportbetween hospitals.