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Purpose/Objective: The purpose of this practice inquiry was to propose the development and evaluation of Information for Parents of Premature Infants (IPPI). The IPPI is an educational handout that increases parent knowledge by discussing the growth and developmental expectations of a premature infant at a particular adjusted age. The IPPI includes: growth patterns; motor development; nutritional requirements; provider contact information; and useful informational resources. Specifically, this tool encourages the PCP to appropriately assess the premature infant's development based on adjusted age, preventing misdiagnosis or needless referrals. The development of the IPPI was guided by the four principles of Levine's model of conservation, and a plan for implementation and evaluation of the IPPI has been drafted utilizing the five components of the RE-AIM framework. Introduction: Each year one-in-nine babies are born prematurely in the United States. Over the last 25 years the rate of premature birth has increased by 36%. Compared to parenting a term infant, parents of premature infants face a significant number of challenges and stress. The cause of such stress is due to a lack of knowledge regarding the unique physical and developmental care needs of a premature infant and the lack of available educational resources that are designed to address this deficit. Rationale: The increased incidence of premature births has placed an enormous burden on primary care providers (PCP) to meet the exceptional health and developmental needs of this vulnerable population. The neurodevelopmental expectations for premature infants vary significantly when compared to those of full-term infants and in addition to the risk for neurodevelopment disabilities there is a significant amount of stress faced by parents. In order to manage the care and physical needs of a preterm infant and have the confidence to bond with their fragile infants, parents need a great deal of support and education regarding the unique physical and developmental needs of their premature infant. Furthermore, parents must rely on the baby's PCP to have the ability to recognize the sequelae that is associated with premature birth and provide appropriate education, anticipatory guidance, resources, and reassurance.

Thesis (Ph.D.)--Michigan State University. Epidemiology, 2008. / Title from PDF t.p. (viewed on July 7, 2009) Includes bibliographical references. Also issued in print.

Thesis (Ph. D.)--University of California, San Francisco, 2004. / Includes bibliographical references (leaves 84-95). Also available online.

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 51-53).

Thesis (D.PT.)--Sage Colleges, 2009. / "May 2009." "A Capstone project for PTY 768 presented to the Faculty of the Physical Therapy Department Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

Thesis (MSLT)--University of Canterbury, 2006. / Typescript (photocopy). Includes bibliographical references (leaves 39-45). Also available via the World Wide Web.

Probiotics and lactoferrin are currently being used in neonatal intensive care units in the hopes of reducing rates of sepsis and necrotizing enterocolitis. While studies have shown that these measures can be clinically beneficial to premature babies, little is known about their effect at the level of the intestinal microbiome. We performed a prospective study describing the composition and evolution of the microbiota of premature babies receiving probiotics with and without lactoferrin supplementation. Furthermore, we compared our findings to a piglet model. We found that the addition of lactoferrin did not lead to a distinct microbiome using UniFrac analysis, nor increased diversity or richness as compared to probiotics alone. The relative abundance of probiotic bacterial strains was approximately 3%. At the phylum level Firmicutes and Proteobacteria predominated, while overall Enterobacteriaceae was the most abundant family. We remain the first to describe the microbiome of premature infants receiving lactoferrin.

The purpose of the study was to identify and compare characteristics of preterm infants' pulse rate, respiratory rate, stress related behavior and self comforting behavior in two situations: (1) the infant receiving routine nursing care in the environment of a neonatal intensive care nursery, and (2) the infant in the same environment after experiencing a gentle back massage. Specifically, the research question for this study was: what patterns of pulse rate, respiratory rate and behavior, are associated with massage? Preterm infants between 33 and 36 weeks gestational age were observed for a baseline period of 50 minutes, given a 10 minute back massage, and observed for an additional 50 minutes. Exploratory data analysis revealed changes in the pulse rate, and in the frequencies of stress related and self comforting behaviors after massage that were associated with gestational age. Younger infants displayed a decline in pulse rate and an increase in respiratory rate after massage when compared to baseline observations, whereas older infants showed an increase in pulse rate immediately following massage. Stress related behavior declined during the first 10 minutes after massage in all age groups. Most preterm infants in this sample did not manifest any stress related behavior for several minutes after the massage. The frequency of self comforting behaviors increased after infants experienced a massage. Behavioral patterns were coupled with physiological variables; the frequency of self comforting behaviors was reflected in the pattern of respiratory rate whereas the frequency of stress related behaviors was more closely coupled with pulse rate. As infants became more aroused, they used a greater variety of behaviors. The behavioral reportoire also increased with gestational age. Content analysis demonstrated that infants spent more time in quiet sleep after having a massage than before massage. There were more frequent changes between active and quiet sleep before massage than afterward among infants who were treated concurrently with ultraviolet light. There was a trend for infants of all ages to take less time to console themselves after having a massage than before. None of these observed differences was statistically significant. Rotational movements were noted among more mature infants and were associated with quiet sleep. Infant behaviors showed a general decrease in the amplitude of movement over time. Several infants appeared alert, opening their eyes and looking around after having a massage. In general, preterm infants in this sample manifested changes in arousal and in activity which were observed in the differences in their behavior and vital signs after having a massage.

It has been repeatedly documented that during mother-infant inter- action, mothers of pre-term infants exhibit higher rates of stimulation than do mothers of full-term infants. The present research explored characteristics of mother and infant which may contribute to this pattern. In Study 1, pre-term and full-term infants were compared on two dimensions of neonatal behavior thought to elicit heightened maternal activity: (1) lesser positive responsiveness and (2) greater irritability or drowsiness. Further, the pre-term sample was divided into two groups (mildly ill, moderately ill) to explore the impact of severity of neonatal medical complications on infant behavior. Assessment of neonatal responsiveness included orientation items and ratings of alertness and state control adapted from the Brazelton Neonatal Behavior Assessment Scale. Pre-terms exhibited less mature visual tracking of moving stimuli than full-terms but showed similar optimal responsiveness to an animate visual and auditory stimulus. Within the pre-term sample, the two illness groups did not differ on any measure. In Study 2, variations in maternal folk theories about special needs of pre-terms were explored. Mothers of mildly ill and moderately ill pre-terms were compared on three sets of attitudes thought to affect maternal stimulation during interaction- -Vigilance, Protection, and Developmental Expectations. Vigilance refers to providing attention, monitoring behavior, and worry about future development. Protection reflects a view of the infant as vulnerable and fragile. Pre-term mothers were also compared to full-term mothers on expectations for infant achievement of cognitive and motoric milestones. Mothers of moderately ill pre-terms expressed more Vigilance attitudes than mothers of mildly ill pre-terms; no difference in Protection attitudes were found. Mothers of pre-terms expected delayed motoric development more frequently than mothers of full-terms. The implications of the findings from these studies for hypotheses about the origins of the high maternal activity pattern were discussed. / This thesis was digitized as part of a project begun in 2014 to increase the number of Duke psychology theses available online. The digitization project was spearheaded by Ciara Healy.