MS, University of Cincinnati, 2025, Medicine: Genetic Counseling

The decision whether or not to receive Secondary Findings (SF) for pediatric patients undergoing whole genome sequencing (WGS) currently requires informed consent from parents. However, limited information is known about the factors influencing parental decisions regarding whether or not to learn SF for their child in the neonatal intensive care unit (NICU) specifically and how prepared parents feel making this decision. Through qualitative interviews, we explored how parents of NICU patients perceive what they have learned about SF in WGS, as well as strategies healthcare providers can employ to enhance parental decision-making support during the consenting process from the parents' perspective. Insights gained from the study inform tailored approaches to counseling and support in the inpatient setting. Interviews were conducted with 20 families whose child had undergone WGS during their NICU stay at Cincinnati Children's Hospital and Medical Center. Questions elicited reasons for receiving or denying SF for their child, what parents considered when making a choice about SF, and any improvements that could be made to SF consent in the NICU. Results from our study describe perceived advantages and disadvantages of SF, including ability to prepare for their child's future and the general idea that more knowledge is better, while reasons for declining SF included more worry and limited access to life insurance. In addition, responses highlight that parents with a child in the NICU value the choice on SF, would like to learn about SF earlier in their diagnostic odyssey, and prefer more physical materials for learning about SF. Responses support the idea that parents of children in the NICU may have different values for SF reporting, and refute the idea that parents are in a state of information overload preventing them from considering SF. Parents often wanted more detailed information on SF, asserting that a tailored approach with inclusion of additional learning mate (open full item for complete abstract)

Committee: Melanie Myers Ph.D. (Committee Chair); Farrah Jackson M.S. (Committee Member); Kimberly Widmeyer (formerly Lewis) MS (Committee Member) Subjects: Genetics

MS, University of Cincinnati, 2025, Medicine: Genetic Counseling

Genetics care providers play a vital role in educating families of children with known or suspected genetic conditions. While many families do not come to the attention of genetics until after a baby is born, a portion of families receive prenatal genetics care for the same indication, often by a genetic counselor (GC). GCs have a unique role as they often provide care to families in both the prenatal and NICU settings. Previous research has focused on the impact of prenatal genetic care (PGC) on expectant parents' feelings of preparedness and understanding of their child's genetic care. However, the time between PGC and inpatient genetics care (IGC) can span weeks or months, during which the phenotype and prognosis of a fetus at risk for a genetic condition may change significantly, including postnatally with new findings. It is unclear whether or how PGC informs parents' experiences of their child's genetic care in the NICU setting. As the uptake of both PGC and IGC continues to increase, information is needed to help genetics providers understand how to best serve families as they navigate the prenatal-to-postnatal transition period and subsequent NICU stay. We conducted semi-structured interviews of 12 parents to investigate the perceived impact of PGC on their preparedness for the child's NICU stay, to elicit their overall experience of genetics care in these settings, and to explore parents' feelings regarding the anticipatory guidance they received during PGC. Interview transcripts were coded alongside retrospective chart review to compare parents' recollections of PGC and IGC with the information documented by their GC(s) to assess the accuracy of parent recollections. Participants described differences in their experience of PGC vs. IGC sessions and appreciated meeting with genetics in both settings. Participants reported they felt more prepared for life with a medically complex child and appreciated the continuity of care from genetics. Participants (open full item for complete abstract)

Committee: Carrie Atzinger M.S. C.G.C. (Committee Chair); Kimberly Widmeyer (formerly Lewis) MS (Committee Member); JACQUELYNN BERTON M.S. B.A. (Committee Member); Melanie Myers Ph.D. (Committee Member); Beatrix Wong M.S. (Committee Member) Subjects: Genetics

PHD, Kent State University, 2025, College of Nursing

The purpose of this study was to evaluate the ability of moral sensitivity, moral distress, ethical climate, and job satisfaction to predict turnover intent in a cohort of neonatal ICU nurses. This study evaluated job satisfaction and moral distress as mediators and ethical climate as a moderator. These complex interactions were better understood through the guidance of the Moral Habitability Framework which strives to explain the moral-social climate of organizations. A sample of 108 neonatal nurses working in Level II, III, and IV ICUs were recruited. A cross-sectional, correlational research design was used to answer the research questions. Pearson correlation coefficients and multiple regression statistics were conducted to analyze the data. Moral distress was reported as low (M = 115.67, SD = 65.15), job satisfaction moderate (M = 45.97, SD = 9.55), ethical climate moderate (M = 50.22, SD = 10.77), and turnover intent as high (M = 18.53, SD = 5.08) with 38.5% (n = 45) reporting considering leaving their current position. Correlations between variables were supported in the analysis. Moral sensitivity, moral distress, ethical climate, and job satisfaction along with demographic variables were found to explain 39.3% of the variance in turnover intent R2 = .393; F(9, 97) = 6.99, p = <.001 with job satisfaction identified as the only significant predictor of turnover intent R2 = .364; F(1,106) = 60.62, p = <.001 explaining 36.4% of the variance. Moral distress was not found to mediate the relationship between ethical climate and turnover intent. Job satisfaction mediated the relationship between ethical climate and turnover intent β = -.356, 95% BCa CI [-.485, -.232] and the relationship between moral distress and turnover intent β = .317, 95% BCa CI [.189, .455]. Ethical climate was not found to moderate the relationship between moral sensitivity and moral distress. The study findings add knowledge about the complex relationships within the moral social environmen (open full item for complete abstract)

Committee: Amy Petrinec Ph.D., RN (Committee Chair); Jonathan VanGeest Ph.D. (Committee Member); Yafen Wang Ph.D., RN (Committee Member); Pamela Stephenson Ph.D., RN (Committee Member) Subjects: Nursing

Undergraduate Honors Program, Malone University, 2025, Honors Thesis

Bonding between a mother and infant is instrumental in creating a healthy attachment for the dyad. In the case of Neonatal Abstinence Syndrome (NAS), dyad bonding can be more difficult because of the infant's withdrawal symptoms, maternal opioid use disorder (OUD), and external factors that can influence maternal OUD and NAS diagnoses. Hospitalization directly following birth is a vital period for implementing nursing interventions that can promote bonding for the dyad early on, creating a foundation for continuation once the dyad is discharged. While several nursing interventions can assist the infant with withdrawal symptoms, the effects these interventions have on dyad bonding are not taken into consideration. This literature review will discuss the most effective nursing interventions that will support the mother and infant in dyad bonding in the context of NAS. This review will also explore the nurse's essential role in helping facilitate environments specific to healthcare settings that are conducive of dyad bonding for the mother and infant. Through understanding the influences of OUD and NAS diagnoses, the importance of dyad bonding in a mother-infant relationship, and the nurse's role in all this, healing connections can be initiated.

Committee: Holly Kibler (Committee Chair); Kathyrn Huisinga (Other); Bryson Davis (Committee Member); Jennifer Hallock (Committee Member) Subjects: Health Care; Nursing

Master of Science, The Ohio State University, 2024, Genetic Counseling

Background: Multiple congenital anomalies (MCA) are often present in rare diseases and ~80% of rare diseases are of genetic etiology. Many patients must undergo a lengthy diagnostic odyssey to identify a molecular diagnosis. The availability of genetics care varies geographically as genetics healthcare providers tend to be based in larger cities or academic institutions. This study aimed to understand geographical barriers to access to genetic healthcare for children with MCA. Methods: This is a retrospective study of Nationwide Children's Hospital (NCH) patients born between January 1, 2015 to September 15, 2023 who had ICD codes indicating MCA. Geographical location (urban or rural), childhood opportunity index, sex, race, ethnicity, NICU admittance, and epoch (whether genetic testing was initiated before or after 1/1/2020) from 6,144 patients were extracted from the NCH Enterprise Data Warehouse. Survival models were developed for two intervals: 1) time from International Classification of Disease (ICD) codes for MCA appearing in the medical record to the first encounter with a clinic capable of ordering genetic testing and 2) time from the first genetic test ordered to the final result received. Models were stratified by NICU admittance. Results: We found that rurality was not associated with time to event in either model. White patients with MCA were seen in testing-capable clinics sooner and more often than non-white patients, however, once seen, white and non-white patients had similar diagnostic odysseys. Patients who had genetic testing before 2020 were less likely to return for further testing with newly available modalities. Females not in the NICU were more likely to complete their diagnostic odyssey after the first genetic test was ordered compared to otherwise similar males. Discussion: These findings highlight disparities between white and non-white individuals for both NICU and non-NICU cohorts when looking at time from ICD codes for MCA appearin (open full item for complete abstract)

Committee: Bimal Chaudhari MD, MPH (Advisor); Rose Hokanson MS, LGC (Committee Member); Kate Shane-Carson MS, LGC (Committee Member) Subjects: Genetics; Health; Health Care; Medicine; Public Health

Doctor of Philosophy, The Ohio State University, 2023, Speech and Hearing Science

Preterm infants are at increased risk for long-term neurodevelopmental sequelae affecting all areas of development. Despite ongoing advances in medical care resulting in infants surviving from increasingly younger gestational ages at birth, the neurodevelopmental implications of extreme prematurity and its requisite NICU stay are not yet fully understood. Furthermore, preterm infants are at increased risk for neural insults, further complicating their developmental progression. Parental involvement in the NICU is a known contributor to improved outcomes; however, barriers to parental presence and involvement often reduce parents' ability to contribute to their infant's care. One potential way for parents to contribute to their infant's care, even if they cannot be present at bedside, is through parent voice recordings, and, particularly, through infant-directed language. However, very little is known about the acoustic properties of infant-directed language to preterm infants, namely infant-directed speech and singing, or how these infants respond to infant-directed auditory stimuli. This dissertation consists of 7 chapters examining infant-directed speech and singing with preterm infants and its potential as an early intervention. The first and second chapters provide a background on challenges associated with preterm birth and current approaches to care in the NICU. Chapter 3 provides the theoretical and neuroscientific basis for the use of infant-directed speech and singing as neurodevelopmental support for preterm infants in the NICU. Chapters 4-6 outline three experiments that sought to better understand how preterm birth affects infant-directed language with preterm infants and their mothers. Chapter 4 focuses on the acoustic features of infant-directed speech and singing of mothers of preterm infants recorded during the perinatal period and discusses those features in the context of well-established acoustic parameters of infant-directed language with (open full item for complete abstract)

Committee: Rachael F. Holt (Advisor); Jennifer P. Lundine (Committee Member); Janet Vuolo (Committee Member); Nathalie L. Maitre (Other) Subjects: Audiology; Music; Speech Therapy

MS, University of Cincinnati, 2022, Medicine: Clinical and Translational Research

Background: There are many benefits of skin-to-skin care for very preterm infants, but little is known regarding its effect on brain development. Our objective is to estimate the effects of skin-to-skin care on neurostructural development using magnetic resonance imaging (MRI) at term-equivalent age in very preterm infants. Methods: The Cincinnati Infant Neurodevelopment Early Prediction Study is an on-going, multicenter, geographically based, longitudinal birth cohort study, with recruitment from September 2016 to November 2019, and neurodevelopmental follow-up to 7 years corrected age. This is a convenience sample of 246 hospitalized very preterm infants born =32 weeks gestational age from five greater Cincinnati area level III/IV neonatal intensive care units. Patients with known chromosomal or congenital central nervous system anomalies or cyanotic heart disease were excluded. There were 395 initially eligible participants, of which 149 were excluded. The primary exposure of interest was number of skin-to-skin care encounters documented in the medical record during NICU admission but prior to brain MRI. Skin-to-skin care was normalized for length of stay. Our outcomes of interest were global brain abnormality score (composite measure of injury and brain immaturity), four measures of cortical maturation (cortical surface area, sulcal depth, gyrification index, and curvature), and relative thalamic volume. Results: From a total of 246 infants with well-documented skin-to-skin care data, 210 with good quality MRI images were included in the analysis. The mean (SD) gestational age was 29.40 (2.48) weeks, and 109 subjects (44%) were female. In propensity score-weighted analyses, skin-to-skin care was significantly associated with increased inner cortical curvature (ß 2.10; 95% CI: 0.18, 4.02; p=0.03) and larger relative thalamic volume (ß 0.16; 95% CI: 0.02, 0.29; p=0.02). We did not observe a significant association between skin-to-skin care and global brain (open full item for complete abstract)

Committee: Scott Langevin Ph.D. (Committee Member); Nehal Parikh D.O. (Committee Member); Shelley Ehrlich M.D. (Committee Member) Subjects: Medicine

MS, University of Cincinnati, 2020, Medicine: Genetic Counseling

Abstract: Importance: Managing health care costs, while providing quality care, has increasingly become a concern for payers and providers. Identifying causes of morbidity and increased costs can aid in finding solutions to improve care in a cost-effective manner. Objective: To determine effect of genetic diagnoses on cost and duration of Neonatal Intensive Care Unit (NICU) admission. Design: Retrospective cohort analysis of patients admitted to a level IV NICU from January 1, 2013 to December 31, 2016. Data was gathered from birth to two years of life. Setting: Cincinnati Children's Hospital (CCHMC) Level IV NICU. Participants: 2,703 patients were admitted to the NICU from 2013 to 2016 and were eligible for this study. The majority of admissions were non-Hispanic (95%), white (73%), and male (56%). Exposures: NICU admission Main Outcomes and Measures: Duration and cost of NICU admission as well as genetic diagnosis status were studied to determine the impact of genetic disease within a level IV NICU. It was hypothesized that patients with genetic diagnoses would have a longer duration and higher cost of admission unrelated to genetic services. Results: Among 2,703 patients, 287 (11%) had genetic diagnoses by two years of age. Individuals with a genetic diagnosis were more likely to be born at term gestation (p<0.001), with a birthweight greater than 2500g (p<0.001), and were more likely to die before two years of age (p<0.001). Patients with genetic diagnoses were discharged from the NICU at a later day of life (DOL) (59 days; range 3-623 days) compared to their counterparts without a genetic diagnosis (44 days; range 0-729 days) (p<0.001), despite no difference in DOL at admission. This lead to a length of stay on average 28 days more than their non-genetic counter parts (p<0.001). There was no difference between those patients with and without a genetic diagnosis (p=0.37). However, the total cost for the entire NICU admission was higher fo (open full item for complete abstract)

Committee: Melanie Myers Ph.D. (Committee Chair); Kathleen Collins M.S. (Committee Member); Hua He M.S. (Committee Member); Kristen Suhrie (Committee Member); Daniel Swarr (Committee Member) Subjects: Genetics

MS, University of Cincinnati, 2019, Allied Health Sciences: Nutrition

Background: In the United States 10% of all infants are born preterm.1 Preterm birth, low birth weight, and NICU admissions put newborns at increased risk of morbidity and mortality.1,2 Breast milk provides NICU-admitted infants with nutritional and immunologic protections including human milk oligosaccharides, secretory IgA, hormones, growth factors, cytokines, and chemokines.3,4 The AAP states the potent benefits of human milk are such that all premature infants should receive human milk, preferably mother's own milk (MOM).5 Objectives: Our objective was to determine the predictors of the following outcomes for NICU-admitted newborns and their mothers: mother attempting breast milk expression (Attempted Expression), mother initiating breast milk expression within 6 hours of birth (EBM First 6h), newborn receiving MOM as first feeding (MOM First Feeding), newborn receiving colostrum for oral care within the first 36 hours of life (COC First 36h), and newborn receiving any MOM at discharge (DC), or day of life 21 (DOL21) if discharged after DOL21 (MOM DC/DOL 21). Methods: We included all preterm infants born at UCMC June 1, 2018 to May 31, 2019 and examined a comprehensive set of socio-demographic, maternal, obstetric, and infant variables as being potential predictors of MOM outcome variables. We built a database by linking mother's medical record with newborn medical record and hand extraction of additional variables from nursing notes, lactation notes, etc. All data were imported into SAS for data analysis. We used chi square analyses to examine the unadjusted associations between independent variables and MOM outcomes. We used logistic regression models to examine the adjusted associations between the independent variables and MOM outcomes. Results: It was found from our fully adjusted logistic regression model that the independent predictors of mother not attempting breast milk expression were active smoking (P<0.0001), multiparity (P=0.03), maternal (open full item for complete abstract)

Committee: Laurie Nommsen-Rivers Ph.D. (Committee Chair); Laura Ward M.D. (Committee Member) Subjects: Nutrition

Doctor of Philosophy, Case Western Reserve University, 2019, Nursing

Parents of infants hospitalized in the neonatal intensive care unit (NICU) are tasked with difficult decisions and sometimes need to decide between initiation or continuation of medical intervention versus withholding or withdrawal. Research has shown that parents cite the importance of maintaining hope; receiving honest information; engaging in dynamic communication; and feeling supported as crucial to the process of decision-making. However, little is known regarding outcomes of decision-making, and more specifically, whether parents are satisfied with the outcomes of decision-making and how this satisfaction or dissatisfaction may relate to the development of post-traumatic stress disorder (PTSD). The purpose of this mixed-methods study was to explore mothers' perspectives regarding the outcomes of decision-making for their surviving infants formerly hospitalized in the NICU, with specific attention to the types of decisions that mothers perceived to be most important, decisional satisfaction, and the development of PTSD, and to further evaluate factors that were related to decisional satisfaction and PTSD through a cross-sectional descriptive questionnaire and semi-structured interview. Forty-four mothers participated. The small sample size dictates that results should be interpreted with caution. Thirty-four percent of mothers desired shared decision-making while 23% perceived that it had actually occurred. Eighty-two percent of mothers were satisfied with the outcome of their decision-making. Higher certainty regarding the decision (p = 0.023) and better neurodevelopmental score (p = 0.029) were significantly related to decisional satisfaction, while lower gestational age at birth (p = 0.068) approached significance. Twenty-seven percent of mothers met clinical cut-off as having diagnosable PTSD and a further 25% had elevated scores just below threshold. Satisfaction with preparation for NICU admission approached significance (p = 0.084) in relationship to d (open full item for complete abstract)

Committee: Donna Dowling (Committee Chair); Christopher Burant (Committee Member); Amelia Bieda (Committee Member); Barbara Daly (Committee Member); Cheryl Killion (Committee Member); Stuart Youngner (Committee Member) Subjects: Health Care; Medical Ethics; Medicine; Mental Health; Nursing

PhD, University of Cincinnati, 2019, Nursing: Nursing - Doctoral Program

Background: The national average turnover rate of bedside nurses in 2017 was 16.8%. Turnover in the nursing profession is costly to organizations, potentially detrimental to patients, and signals underlying issues within an organization. Among many things, these underlying issues may stem from job dissatisfaction or nurse burnout, both of which have been linked to turnover. It remains unclear whether other factors contribute to these nurse outcomes, such as the inability to keep up with professional requirements of care—also referred to as missed nursing care. Missed nursing care, a relatively new topic in the literature, has been associated with adverse patient and nurse outcomes. Less is known about the relationships between nurse turnover, job satisfaction, burnout, and missed care among nurses who work in neonatal intensive care units (NICU). Aim: The aim of this study was to examine relationships between burnout, missed nursing care turnover status, and job satisfaction among NICU nurses. Methods: A secondary analysis of nurse-level data was conducted. A total of 136 registered nurses working in a 52-bed level IV NICU reported on burnout (emotional exhaustion, depersonalization, and personal accomplishment), missed nursing care, turnover status, and job satisfaction between March 2013 - January 2014. Results: A total of 16.9% of nurses in this study turned over. There were no statistically significant relationships found between any dimensions of burnout (emotional exhaustion (EE), depersonalization (DEP), and personal accomplishment (PA)) and turnover (p >.05). However, there was a statistically significant association found between burnout dimensions of emotional exhaustion and depersonalization and the outcome of job satisfaction (EE: Beta = -0.38, p <.001; DEP: Beta = -0.26, p <.001). There was no evidence to support missed care as a mediator between burnout and the outcomes of turnover and job satisfaction. Conclusion: This study provided evide (open full item for complete abstract)

Committee: Tamilyn Bakas PhD (Committee Chair); Kimberly Johnson PH.D. C.E.N. (Committee Member); Elaine Miller Ph.D. (Committee Member); Heather Tubbs Cooley (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2018, Nursing

Low birthweight is a serious public health problem in the United States, affecting 8% of all births with severe regional and ethnic disparities. Low birthweight children have previously been found to have persistent deficits in both general cognition and domain-specific cognitive outcomes. These deficits limit educational attainment, socioeconomic mobility, and quality of life. Current strategies for referral to early intervention services rely on waiting for significant delays to develop or referring all infants below a threshold birthweight or gestational age. Thresholds vary between settings and considerable variation exists in outcomes even for “low risk” low birthweight infants. Thus, referral criteria beyond birth weight and gestational age are needed.. Social contexts and genetic variation both play important roles in the development of cognition. Low birthweight infants may be more susceptible to harmful effects of social contexts and genetic variation based on their comparative physiologic fragility and altered early life experiences. This study examined possible explanations for risk variation in cognitive outcomes of low birthweight children using data from the Fragile Families and Child Wellbeing Study, a nationally-representative longitudinal cohort. Specifically, our aims were to examine relationships between cognition in low birthweight, school-aged children and 1) early life social contexts, and 2) genetic variants of COMT, BDNF, and SLC6A4. To address the first aim, we constructed a standardized composite of four measures of general and domain-specific cognition and developed a series of models to estimate the effect of social contexts on cognition in low birthweight children at age 9 years (n = 140). A panel of social contexts (i.e. risk and protective factors) that were measurable at the birth of the focal child were selected based on prior empiric and theoretical relationships to child development. Our final model was statistically significant (open full item for complete abstract)

Committee: Cindy Anderson PhD (Committee Chair); Rita Pickler PhD (Committee Member); Jodi Ford PhD (Committee Member); Paul Gugiu PhD (Committee Member); Cindy Munro PhD (Committee Member) Subjects: Nursing; Statistics

Doctor of Philosophy, The Ohio State University, 2016, Nursing

Extremely premature infants, born at 28 weeks gestation or less, are at greatest risk for poor neurodevelopmental outcomes. While survival of these infants has improved in the past decade, neurodevelopmental outcomes have not. Because early life experiences affect brain structure and function, the quality of these experiences is one of the most important factors affecting optimal development. Reliable markers of neurobiological processes underlying development are necessary so that research can accurately monitor mediators of neurodevelopmental outcomes. Oxytocin (OT) has the potential to be a neurobiological marker of social processes that offer neuroprotection for the infant. OT acts as a buffer for the stress response system and provides protection to the brain during inflammation, ischemia, or injury. OT has been strongly linked to neurodevelopmental outcomes in animal models, particularly those outcomes related to social cognition and emotion regulation. No studies measuring OT have been conducted in premature infants, nor has the association of oxytocin levels and neurodevelopment for these infants been investigated. The purpose of this study is to 1) describe OT levels in plasma, urine, and saliva in premature infants through 34 weeks gestation and 2) determine if OT levels vary with maternal-infant interaction, neurobehavioral organization, and infant stress exposure. Thirty-seven premature infants, born gestational ages 25-28 6/7 weeks, were longitudinally followed until 36 weeks gestation. Plasma and urine samples were collected at 14 days of life, then weekly until 34 weeks. Data on infant and environmental variables were abstracted from the electronic medical record. Infant social engagement behaviors was measured by the Parent-Child Early Relational Assessment, during a videotaped feeding when the infant was at one-quarter full oral feeds. Infant stress exposure was measured weekly by the Neonatal Infant Stressor Scale. Neurobehavioral organization wa (open full item for complete abstract)

Committee: Deborah Steward (Advisor); Tondi Harrison (Committee Chair); Abigail Shoben (Committee Member) Subjects: Neurobiology; Nursing; Psychobiology

Master of Science (MS), Ohio University, 2015, Child and Family Studies (Health Sciences and Professions)

Infant's hospitalization soon after birth often causes the family system to adjust to new or different roles while typical routines may change. Medical professionals as well as Certified Child Life Specialists (CCLS) can assist children and their families who are navigating the hospital environment. Through questionnaires completed by CCLS and an interview with a parent who had a child in the Neonatal Intensive Care Unit (NICU), a deeper understanding was reached regarding what CCLS can provide children and their families in the NICU setting.

Committee: Jenny Chabot CCLS (Committee Chair); Joan Jurich (Committee Member) Subjects: Families and Family Life; Health Care; Health Sciences; Medicine

MA, University of Cincinnati, 2001, Allied Health Sciences : Communication Sciences and Disorders

The purpose of this study was to add to the limited current knowledge regarding the preverbal speech and language skills of hospitalized medically fragile infants with and without tracheostomies. The preverbal speech and language skills of twenty-seven hospitalized infants ranging in age from 2 days to 22 months were evaluated using the Rossetti Infant-Toddler Language Scale (Rossetti) (Rossetti, 1990). The amount of vocalization and eye contact made by the infants during adult interaction was also recorded. The study found a delay in the overall speech and language development of all subjects older than three months. Additionally, on the average subjects achieved fewer of the language expression skills examined by the Rossetti than any other language domain studied, including interaction/attachment, pragmatics, play and language comprehension.To make comparisons of speech and language development among medically fragile infants, subjects were divided into three groups: infants with tracheostomies, premature infants, and infants with medical complications other than tracheostomy or prematurity. Subjects with tracheostomies produced significantly fewer vocalizations in a set observation period than both of the other subject groups. This finding suggests that preverbal speech and language intervention for infants with tracheostomies should be prioritized, as this population may be at even higher risk for delayed communication than other medically fragile infants. The finding that on the average subjects of all ages scored the lowest proportions in expressive language suggests that decreased vocalizations may be the best predictor of later speech and language delay in medically fragile infants. Further research is necessary to determine if any of the delayed preverbal skills found in this study among medically fragile infants are indicators of future communication delays.

Committee: Kenneth Ruder (Advisor); Ernest Weiler (Other) Subjects: Health Sciences, Speech Pathology

Doctor of Philosophy, The Ohio State University, 2012, Nursing

End-of-life (EOL) care for neonates admitted to the Neonatal Intensive Care Unit (NICU) is understudied and practice varies widely across centers and providers. We just do not have a clear understanding of those physiologic processes and other factors that can impact the quality of a neonatal death in the NICU. By not paying close attention to, and then not appropriately treating the symptoms the critically ill neonate expresses as death approaches, we may very well be depriving these infants and their families the opportunity for the “good” death one might hope for an infant. This dissertation work includes a proposed new model for evaluating the quality of a neonatal death that, with testing, will hopefully provide insight and guidance for clinicians who must coordinate care of parent and child at the end of life. Several characteristics and relationships need to be further evaluated, however this new framework will offer a good approach until more definitive knowledge is discovered. Next, an exploratory study is presented examining how dying neonates are currently being cared for in the NICU. Finally, discussion unfolds regarding several methodological issues encountered in EOL care research that makes it incredibly difficult to study this important topic. There is much room for improvement in our understanding so that we may deliver the absolute best end-of-life care possible for these special babies.

Committee: Deborah K. Steward PhD (Advisor); Victoria Von Sadovszky PhD (Committee Member); Pamela Salsberry PhD (Committee Member) Subjects: Nursing

Doctor of Philosophy, Case Western Reserve University, 2011, Nursing

Although music therapy has been shown to benefit premature infants in terms of physiologic and behavioral responses, and growth, it is not yet widely used in the care of preterm infants. This may reflect the NICU staffs' perception of the effectiveness of music therapy and their ability to promote music therapy in the NICU environment. However, there is no information available on NICU staff nurse perceptions of music therapy in Thailand. Therefore, the purpose of this study was to explore the relationship among staff nurses' beliefs, attitudes toward music therapy, subjective norms, perceived behavioral control, and intentions to learn more about music therapy and to support its' use in NICUs in Thailand. This study used a descriptive, correlational, cross-sectional research design, utilizing the theory of planned behavior (Ajzen, 1991). The NICU Music Therapy Questionnaire (NICU MTQ) developed by the investigator measured all of the variables in this study. Participants in this study were 85 staff nurses from a NICU and a step-down unit of one large tertiary hospital in Thailand. The findings revealed that the participants lacked experience with music therapy but nonetheless demonstrated positive attitudes, beliefs, and intentions related to music therapy. The relationship between each salient belief and attitudes, subjective norms, and perceived behavioral control had highly positive correlations. The overall model demonstrated all three predictors (attitudes, subjective norms, and perceived behavioral control) significantly influenced the staff nurses' intention.

Committee: Marilyn Lotas (Committee Chair); Donna Dowling (Committee Member); Marion Good (Committee Member); Deforia Lane (Committee Member) Subjects: Health Care

Master of Sciences, Case Western Reserve University, 2010, EECS - Electrical Engineering

This thesis discusses the design, development and, construction of a device to be deployed in the Neonatal Intensive Care Unit (NICU) to provide health and developmental benefits to premature infants in an incubator setting. The device, hereafter referred to as KUDDLER, provides customized access to Kangaroo Care for premature infants in the NICU when they cannot be with their mothers. One of the important features of KUDDLER is that it can be customized to the unique respiratory and heartbeat patterns of the mother. During setup of the unit, the mother's heartbeat and respiration signals are recorded and stored in a computer for future use. The KUDDLER is then placed in an incubator and the infant is placed on top on the device. The KUDDLER is operated from a computer that is located on a cart and oscillates up and down with the same respiratory rhythm that would be experienced in direct contact with the mother and a speaker on the back of the device provides the mother's heartbeat sounds. The KUDDLER also retains the heat of the surrounding incubator to provide proper warmth for the neonate.

Committee: Kenneth Loparo PhD (Advisor); Susan Ludington PhD (Committee Member); Mark Scher MD (Committee Member) Subjects: Electrical Engineering