Date of Award

Spring 2021

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Robin Dail


The advanced survival of the early premature infant (EPI) since the post-surfactant era has not improved many comorbidities. EPI comorbidities influence their lifelong health, social, and cognitive outcomes. EPIs often have immature and disorganized responses to stimuli during the neonatal period. EPIs respond to stressors from the Neonatal Intensive Care Unit’s (NICU) environment, stimulation, or disease states based on physiologic system changes, often resulting in observable behavioral changes. Both physiologic and behavioral changes reflect autonomic nervous system (ANS) disruption, thus instability. Instability of the ANS due to chronic stressors, can lead to chronic physiologic dysregulation and lead to lifelong health comorbidities. Avoiding of instability in the ANS is crucial to prevent brain injury. Neonatal nurses are uniquely positioned to identify early indicators of behavioral and physiologic instability, allowing them to guide care that will prevent or reduce short and long-term comorbidities in the EPI. The best indicator of EPI instability is not yet known; therefore, the goal of this research was to identify indicators of EPI ANS instability, using physiologic and behavioral measures. Identification of early indicators of EPI instability can be utilized to optimize care plans for EPIs. This dissertation presents: the current state of the science; historical, conceptual, and theoretical frameworks; and, methodological approaches of research, which examine relationships between EPI instability and their behavioral and physiologic responses. A mixed methods, multiple subject within-case research study and results are presented, in addition to a discussion regarding the development of further scientific evidence.


© 2021, Karen Popp Becker

Included in

Nursing Commons