Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson Jane M. Georges, PhD, RN Gabriella Malagon-Maldonado, PhD, DNP, RN, NEA-BC


Neonate, NICU, Bayley III, Neurodevelopmental outcomes, toxic stress, family centered care


Background: Evidence suggests the presence of complex biologic connections between the social environment, neurologic development, and long-term health. Premature infants spend many months in the Neonatal Intensive Care Unit (NICU) often separated from their parent(s). Decrease in the age of viability threshold allows extremely preterm infants to benefit from lifesaving therapies; however, they are frequently exposed to significant stressors that increase their risk for adverse neurodevelopmental outcomes.

Purpose: The purpose of this study is to examine the relationship among socio-demographic factors, exposure to stressors in the NICU environment, stress modifiers/buffers, neonatal morbidities at discharge, and 1. 2-year neurodevelopmental outcomes and 2. risk for autism in infants born less than 32 weeks gestational age cared for in a large, urban, tertiary NICU.

Conceptual Basis: Mefford’s Theory of Health Promotion for Preterm Infants and D’Agata’s Infant Medical Trauma in the NICU.

Methods: A retrospective cohort design

Findings: Final models were computed for Bayley III cognitive, language, and motor composite scores. All significant predictors at the p < 0.05 level were included in the model, controlling for gestational age. Sociodemographic factors influenced long-term neurodevelopment at 2 years of age. Parent presence in the NICU was an important predictor for cognitive outcomes at 2 years of age. The multivariable regression model explained 23.7% of the variance in Bayley III cognitive composite scores: R2 = 0.237, R2 adj. = 0.148, F(26, 225) = 2.681, p < .001; 26.1% of the variance in Bayley III language composite scores: R2 = 0.261, R2 adj. = 0.187, F(23, 228) = 3.504, p < 0.001, and 26.1% of the variance in Bayley III motor composite scores at 2 years of age: R2 = 0.175, R2 adj. = 0.108, F(19, 232) = 2.599, p < 0.001.

Research Implications: Identification of modifying factors influencing negative effects of prolonged stress in preterm neonates may lead to identification of interventions to alter the trajectory of long-term neurodevelopmental outcomes for infants discharged from the NICU. Further research is needed to identify the impact parent presence, nurse-guided family centered developmental care interventions, staffing models, and pain/stress exposure have on short and long-term neonatal outcomes.

Document Type

Dissertation: Open Access



Available for download on Wednesday, April 26, 2023