Emory Nursing, Autumn 1998 - From bedside to bench and back

 



Moving Toward the Light


Lynn Lotas, RN, PhD

Nursing is a practice discipline," says Lynn Lotas, director of the Office of Research Affairs at Emory's nursing school, "and as a result most of our research questions will invariably come out of clinical practice." This belief is evidenced every day in Dr. Lotas' own research on premature infants.

The germ for that research was planted in the early 1970s as Lotas finished a master's in psychology at Wayne State in Detroit (where she had previously earned a BSN). Through the psychology program, she became intrigued with neurophysiological development. She continued this interest through her MS and PhD at the University of Michigan, where she studied child and family development and spent four years as a clinical trainee working with developmentally delayed children and adults. She then moved to Ohio State where she served as faculty and worked in a follow-up clinic for high-risk infants.

In 1988, Lotas was awarded a Robert Wood Johnson postdoctoral clinical scholarship, a pivotal point in her career. "The Robert Wood Johnson funding provided me with the resources to continue my program of research with preterm infants," she says, "particularly their neurobehavioral development as impacted by the neonatal intensive care nursery environment." Lotas has pursued this interest throughout the 1990s, a decade in which she has also served as department chair and director of the perinatal and neonatal nurse practitioner program at the University of Texas Health Science Center at Houston. Lotas came to Emory in 1996 because of the opportunity to encourage other researchers while continuing her own studies.

Continuous versus Intermittent



While Lotas' early work took place in intensive care nurseries, her later studies moved to a laboratory setting as she came to realize that the hundreds of variables affecting development in premature human infants could not otherwise be controlled easily, even in a hospital environment. But a newborn animal environment can be regulated, she found. Most recently, using newborn piglets, Lotas has conducted work that looks at the impact of light and dark cycles, as well as the effect of continuous versus intermittent feeding, on the growth of and energy expenditure in newborn animals. (Following three weeks of examination, the well-fed pigs are returned to the farm.)

What Lotas found is that the animals which were fed intermittently and exposed to light and dark cycles in structured patterns grew significantly faster than the ones that weren't. When an infant is born prematurely, he or she is often placed in an environment of continuous lighting and, frequently, continuous feeding. A major concern, then, is what happens to the baby when the effects of the mother's biorhythms are lost and the usual environmental organizers of infant biological rhythms - i.e., light/dark cycles and intermittent feeding - are unavailable. This combination of events may dramatically impact the way the infant grows and develops.

"We know that exposure to continuous bright lighting over a period of several days can lead to psychological disturbance in adults," Lotas says. "We are still in the process of understanding fully the effects on preterm infants. Good evidence exists to show the positive effects of dimming the nursery lights, but it is less clear whether or not light/dark cycling is important."

Lotas just completed a survey of 70 neonatal intensive care nurseries to determine what their current lighting patterns are like. About half of the nurseries are dimming the lights systematically, she found, and half are not. "Just as there are no definitive data to support the recommendation that nurseries should maintain regular light/dark cycles," Lotas says, "there are no data as yet to document how dim the lights should be if they do dim them, or whether the optimal light level should vary depending on the gestational age of the infant. There are many research questions yet to be answered in just this one small area of premature infant development."

Lotas' work in studying the effects of light/dark cycles and intermittent feeding patterns on preterm infants will focus next on the influence of these variables on the development of infant sleep cycles and their impact on growth hormone secretion levels.

Anticipating a Shift in Culture

In the nearly three years she's been at Emory, Lotas has been active in the planning of the School of Nursing's new doctoral program and says she is eager to see it implemented.

"I'm one of several faculty here who have been at other schools when a doctoral program was instituted - and who have lived to tell the story of the changes in culture and emphasis that take place," she says. "Instead of research just being talked about, its content seeps into every aspect of a school's function. The focus changes to an atmosphere where questions are continually being asked and answers sought. It goes without saying that such a profound shift in culture and focus takes a great deal of work, but it is also a great deal of fun and an immensely rewarding experience. I believe it is enriching for alumni, too, in that the value of their degree is proportionately increased, as are their opportunities to interact with faculty and the doctoral candidates in the new environment. It's truly a win-win proposition for nursing at Emory."

 


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Last Updated: December 31, 1998