Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Mary C. Sullivan


Little is known about the psychobiological processes of adults, at age 23 who were born prematurely. Compared to infants born at term, premature infants face additional obstacles of immature body systems, more neonatal stress and are at risk for developmental delay and possible parental overprotective patterns. The Developmental Origins of Health and Disease theory asserts that early prenatal and neonatal stress disturbs hypothalamic-pituitary-adrenal (HPA) axis function, which in the long run, affects later health and behavior. The purpose of this secondary analysis is to examine neonatal stress of prematurity on coping, emotional intelligence, physiological responses, developmental milestones and emotional health at age 23 years in a sample at risk for HPA dysfunction.

Prematurely born age 23 year olds, categorized into four groups of medical risk were compared to a term-born group on measures of: Daily Hassles Stress, Coping Response Inventory-Adult, Bar-On EQi, Adult Self Report and salivary cortisol responses in the Trier Social Stress Test. Significant differences in cortisol slope, between the term and premature medical risk group with high stress coupled with lower and upper socioeconomic status, were found as well as differences in total cortisol AUCg levels between premature groups. Significant differences in cortisol slope values were found for all 23 year olds with Adult Self Report psychological clinical problems. This study supports the HPA Axis stress response as a biomarker of premature birth and of psychological clinical problems. Preventative and clinical interventions for young adults to reduce and actively manage problems can promote adaptive emotional health behaviors and later physical health.



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