PROJECT SUMMARY/ABSTRACT Being born preterm is associated with long-term developmental delays that may not be apparent until well after Neonatal Intensive Care Unit (NICU) hospitalization. Researchers have examined the potential effects of being born preterm and neurodevelopmental outcomes and found that preterm infants have increased motor, behavioral, and cognitive morbidities when compared to their term counterparts. These risks are increased for Black/African American infants and male infants. Routine nursing care is a known, even though necessary, stressor. However, mechanisms linking care to stress responses and sleep states in preterm infants is not fully understood. The purpose of this study is to examine the effects of routine nursing care on stress and sleep states in preterm infants. The specific aims are to: determine the relationship between routine nurse caregiving and the post-caregiving stress response among preterm infants; and determine the relationship between routine nurse caregiving on preterm infants’ post-caregiving behavior state. Secondary aims are to: examine the relationships among stress and sleep states pre- and post-caregiving; explore the potential moderating effect of history of stress exposure on effects of routine caregiving on stress response and behavior states following care; and explore the potential moderating effect of pre-caregiving stress response and behavior state on the relationship between routine caregiving and stress response and behavior state post-caregiving. We will consider differences in biological sex and race in all analyses. We propose a non-experimental, descriptive, observational study of 30 preterm infants born between 28-32 weeks gestational age. We will observe one nurse caregiving event, recording stress exposures, stress responses, and behavior states. Stress exposures will be measured using the Neonatal Infant Stressor Scale and data from the electronic health record. Stress responses will be measured using salivary cortisol and skin conductance response. Sleep behaviors will be measured using the Anderson Behavioral State Scale. The study findings will increase our understanding of the effects of routine nurse caregiving on the stress response and sleep behaviors in preterm infants in the NICU. These findings can lead to improved caregiving practices, thus, improving neurodevelopmental outcomes. This study aligns with the National Institute of Nursing Research’s strategic plan for prevention and health promotion by addressing a clinical model of care. The research is an important step in the development of targeted interventions to optimize neurodevelopmental outcomes for preterm infants. The training plan will provide numerous formal and informal opportunities for professional development while allowing building a solid foundation for a successful career as an independent researcher. This study builds on the applicant’s experiences as a NICU nurse and research assistant and integrates her knowledge of nursing care delivery, infant and child development, and research methods.

Narrative The purpose of this study is to examine the relationships between routine nursing care, stress, and sleep in preterm infants. Stress exposure and disrupted sleep behavior early in life may lead to poor long-term outcomes. The findings will help identify areas to improve care to support healthy development.