Date of Completion

12-10-2015

Embargo Period

12-7-2015

Keywords

NICU; Neonatal Intensive Care; Trauma; Infant Medical Trauma; FKBP5

Major Advisor

Dr. Jacqueline McGrath

Associate Advisor

Dr. Erin Young

Associate Advisor

Dr. Xiaomei Cong

Field of Study

Nursing

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

Infants who begin life in the medicalized environment of the neonatal intensive care unit (NICU) do so under adverse conditions. The NICU experience exposes infants to experiences that are different from well newborns. The impact these cumulative adverse conditions have on long-term neurodevelopment has yet to be fully elucidated, however the literature reveals a broad scope of later life challenges for former NICU infants. This dissertation focuses on several novel inquiries that may shed light on individual vulnerabilities. First, a framework of infant trauma is proposed to support improved understanding of the infant experience. Context is provided for the history of neonatal care, unmet expectations of newborns that require NICU care and opportunities for enhanced neurodevelopmental care. Next, the current NICU model of care is discussed from the perspective of a complex adaptive system framework. The complexities of NICU care and agents enmeshed within the system most influential to NICU outcomes; specifically parent, nurse and organization. Suggestions to incorporate parents as co-primary caregivers are offered. Lastly, is an investigation of stress-associated gene, FKBP5, and the potential genetic susceptibility to neurodevelopmental outcomes. Despite the small sample size, genetic susceptibility may be at play when considering how infants adapt to the stressful experiences of the NICU in relationship to neurobehavioral outcomes prior to NICU discharge. As a complete dissertation, these manuscripts provide evidence for a program of research focused on articulating the NICU infant experience and investigating the impacts of both the stress exposure in relationship to genetic vulnerability in the NICU.

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