Providing a thriving environment to preterm infants receiving care in the neonatal intensive care unit is an ongoing area of interest to stakeholders interested in infant health. With advances in monitoring technology, there are new methods to assess the effects of care on preterm infants. Effects of neonatal handling have been analyzed in terms of physiological, behavioral, and pain responses. Further assessment of the effects of handling is needed to determine the impact, if any, on renal and cerebral regional oxygenation in moderate to late preterm infants (34-36 6/7 gestation). A conceptual model was developed based on pertinent theoretical frameworks that include General Adaption Syndrome, Roy’s Adaptation Model, and the Synactive Theory of Development. This conceptual model identifies the preterm neonate, the influence of the environment, and the adaptation processes exhibited by the neonate. In this study a descriptive design using prospective observation was utilized and was conducted in the neonatal intensive care unit at a Magnet® designated acute care hospital. Moderate-late preterm infants were observed for a continuous maximum six-hour period. Moderate to late preterm infants were monitored by near-infrared spectroscopy and pulse oximetry. The handling events were logged in real time into a time-stamped procedure log in Microsoft® Excel and demographic information was collected. The goal of the study is to examine the effects of single versus ‘clustered’ or multiple handling procedures on regional (cerebral and renal) oxygenation, heart rate, and systemic oxygenation. The data was analyzed using analysis of variance (ANOVA), Kruskal Wallis, and multiple linear regression models were used in the statistical analysis. The results of this study were that reductions in cerebral and renal oxygen saturation were significantly greater in neonates exposed to clustered care procedures. Similar results were also found with systemic oxygen saturation and heart rate. The results suggest that care delivery to preterm neonates may need to be modified. However, despite the statistical significance of these results, the clinical significance is not yet known. A larger sample size as well as an examination of specific outcome measures (biochemical markers of hypoxia, weight gain, number of days in the hospital etc.) are required.

LLU Discipline





School of Nursing

First Advisor

Ellen D’Errico

Second Advisor

Danilyn Angeles

Third Advisor

Fayette Nguyen Truax

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Infant, Premature; Respiratory Physiological Phenomena; Outcome Assessment, Health Care; Intensive Care Units, Neonatal



Page Count

xiii, 111 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives