National Association of Neonatal Nurses logo.

2015 Small Grant Winner

Lauren M. Head, BSN RN

Emory University Nell Hodgson Woodruff School of Nursing
Language Exposure in the NICU As a Modifiable Determinant of Neurodevelopmental Outcomes in Very Preterm Infants

At what institute are currently conducting your research?
I am a doctoral student in the PhD program at Emory University Nell Hodgson Woodruff School of Nursing. I will be conducting my research in the NICUs at Emory University Hospital Midtown and Grady Memorial Hospital and at the Emory-Children's Center Developmental Progress Clinic in Atlanta, GA.

What is the main focus of your research?
Preterm birth interrupts a critical period of auditory and brain development and increases the risk for delayed language acquisition and poor academic achievement. In addition to biological vulnerabilities conferred by preterm birth, the risk for cognitive or language delays may be compounded by inadequate language exposure in the neonatal intensive care unit (NICU). Previous studies suggest that only 2-3% of the auditory stimuli in the NICU is language and that early language exposure has a profound influence on a child's early cognitive and language development, emergent literacy skills, and academic trajectory. However, research examining the influence of early language exposure on a child's developmental trajectory has been exclusively conducted with term infants, with the exception of one study. To date, no studies have examined factors that influence the language environment in the NICU.

My research focuses on investigating the effect of the quantity and quality of early language exposure in the NICU on very preterm infants' neurodevelopmental outcomes at 12 months corrected gestational age, controlling for the home environment and clinical risk factors. I will be using innovative technology designed by the Language Environmental Analysis (LENA) Foundation that automatically records and processes speech to collect data on the language environment of the NICUs when the very preterm infant is between 32-36 weeks postmenstrual age. I will specifically be looking at the number of words spoken to the infant as well as conversational turns (back-and-forth conversations between an adult and an infant; very preterm infants make pre-verbal vocalizations as early as 32 gestational weeks). My research also seeks to characterize the language environment of the NICU and to identify contextual factors, including parent demographics, parental self-efficacy, family visits, and clinical risk factors, that influence the early language environment of very preterm infants in the NICU.

How did receiving the NANN Research Institute's Small Grants Award positively impact your career?
I am more than grateful to have received the NANN Research Institute's Small Grants Award and am extremely honored and humbled for NANN's interest in my research. This research grant provides me with the necessary funds to conduct my dissertation study in a field that I am deeply passionate about and that I believe will advance the science of developmental care for high-risk infants. Successfully completing this study will be my first step as a clinical and translational nurse scientist focused on investigating early language exposure and promoting educational achievement in high-risk infants. This study will enhance my understanding of language exposure, further my knowledge of preterm infant development, and develop my skills in research, recruitment, and data collection and analysis.

Why is your work important and how does it advance the field of neonatal nursing?
Although advances in neonatal care have resulted in increased survival of very preterm infants, the high rates of neurodevelopmental delays and poor educational achievement among this population remain both a nursing and public health concern. Language exposure in the NICU is modifiable and may influence a child's developmental trajectory
This study will fill gaps in the neonatal literature about the language environment of the NICU and how it affects preterm infants. Results of this study could provide targets for education or an evidence-base for an intervention to improve the developmental sequellae of the smallest infants in our society and reduce educational disparities between preterm and term-born children attributable to differences in early language environments. Most immediately, this study relates to Georgia's Talk with Me Baby intervention that aims to train nurses to educate parents about the importance of talking with their baby. As such, this study has high translatability to interventions that could influence the clinical practice of neonatal nurses. This study aligns with the NANN Research Institute's research priorities to address long-term developmental issues, expand the evidence for developmentally appropriate care, and empower parents to become active participants in the care of their infants.

In what ways does NANN membership add value to your professional development?
NANN membership has increased my awareness of current research priorities, advocacy issues, clinical advances, and new technological developments in the field of neonatal nursing. It has connected me with neonatal nurses across the country who share the same aspiration of helping all infants reach their full potential regardless of the complications they face early in life. NANN offers an unprecedented opportunity to draw on the expertise of other nurse clinicians and researchers throughout the country through engaging in questions and discussions about current clinical practice and professional issues in neonatal nursing. The peer-reviewed Advances in Neonatal Care journal has served as a wonderful resource for me to understand the scientific foundations of clinical practices and to stay up to date on current neonatal nursing research others are involved in. I anticipate that as my career progresses that my NANN membership will prove even more to be an invaluable resource for my professional involvement in clinical practice, advocacy, and research.