Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Human Ecology

Major Professor

Connie Steele

Committee Members

Sharon Judge, Susan Benner


Technological advances in neonatal care have resulted in a dramatic rise in the survival rate of premature infants. However, knowledge is limited regarding the preterm infant's stress reactivity and the most effective methods to reduce the stress response. This research was designed to investigate stress reactivity in preterm infants and to determine the effect of the intervention strategy of Skin-to-Skin Care (SSC) on the stress response.

Twelve preterm infants meeting eligibility criteria established by the approved guideline for SSC in a level HI neonatal intensive care unit (NICU) participated in this study. The cardiopulmonary parameters of heart rate, blood pressure, and respiratory rate were monitored. Adrenocortical responses were determined by changes in levels of concentration of salivary cortisol.

Stress reactivity was determined by changes in cardiopulmonary parameters and adrenocortical responses to an invasive stressor, defined in this study as a routine heelstick procedure. Stress reactivity was evaluated under the following test conditions: baseline measures of dependent variables in bed, SSC without invasive stressor, invasive stressor in bed, and invasive stressor in SSC.

Changes in the values of the cardiopulmonary parameters and salivary cortisol concentration levels indicated that the preterm infants regulated their responses to aversive stressors differently when they were in SSC than when they were not in SSC. The differences found under these test conditions supported the research hypotheses that providing organizing postural support during SSC reduces stress reactivity in preterm infants in the NICU as reflected by changes in adrenocortical function. Significant changes in cardiopulmonary measures were not demonstrated.

The results of this study improved understanding of the mechanism undergirding the process of co-regulation. The clinical implications provide valuable information for medical professionals challenged to implement care in the NICU in a way that reduces destabilizing stress responses of premature infants to the repeated intrinsic and extrinsic stressors experienced during the hospitalization period following a premature birth.

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