The purpose of this exploratory study is to measure cerebral oxygenation longitudinally in premature infants and evaluate how environmental variables controlled by nursing, positioning and noise, affect cerebral oxygenation. Each year approximately 500,000 infants are born prematurely in the United States and the rate continues to increase every year. A technology new to intensive care nurseries (ICN) called near-infrared spectroscopy, used in cerebral oximetry monitors to measure cerebral oxygenation is beginning to enter the clinical setting. Adoption of this new technology has the potential to reduce premature infant morbidity and mortality;however, information about normal levels of cerebral oxygenation in premature infants at each post-menstrual age is not available. Cerebral oxygenation monitoring could identify rapid or severe fluctuations in cerebral blood flow that are hypothesized to lead to intraventricular hemorrhage (IVH). In addition, environmental factors such as positioning and noise levels may affect cerebral oxygenation in premature infants. However, whether position changes or noise levels affect cerebral oxygenation is unknown. In order to effectively use cerebral oximetry, more must be known about cerebral oxygenation in premature infants and the effects of these nursing and environmental factors. Methods: This study will enroll 35 infants born less than 32 weeks gestational age at Duke University Hospital. Cerebral oxygenation will be measured between birth and 48 hours, between 49 and 96 hours, on day of life 7, and then every 7 days thereafter until discharge or 40 weeks post-menstrual age. Infants will be placed supine with head midline for the first 10 minutes to determine developmental trajectories and the last 10 minutes infants will be randomized to a second position to determine if position affects cerebral oxygenation levels. Sound levels will be recorded throughout the entire 20-minute assessment to determine whether peak noise levels affect cerebral oxygenation levels. Training Plan: The proposed training plan is designed to enhance my current knowledge of neonatal research and increase my ability to participate in research design by engaging in coursework, conferences, ethical training, nursing faculty lectures, pediatric nursing meetings and education, and neonatal grand rounds. Relevance to Public Health: Results from this study will provide intensive care nurseries with developmental trajectories of cerebral oxygenation to serve as a guide for clinicians to determine if premature infants are at risk for IVH. Additionally, this study will determine the influence of positioning and sound on cerebral oxygenation and allow neonatal nurses to provide developmentally appropriate care for premature infants.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZNR1-REV-W (02))
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Banks, David
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Duke University
Schools of Nursing
United States
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Elser, Heather E (2012) Positioning after feedings: what is the evidence to reduce feeding intolerances? Adv Neonatal Care 12:172-5
Elser, Heather E; Holditch-Davis, Diane; Levy, Janet et al. (2012) The effects of environmental noise and infant position on cerebral oxygenation. Adv Neonatal Care 12 Suppl 5:S18-27
Elser, Heather E; Holditch-Davis, Diane; Brandon, Debra H (2011) Cerebral Oxygenation Monitoring: A Strategy to Detect IVH and PVL. Newborn Infant Nurs Rev 11:153-159