Human interaction in the NICU and its association with outcomes on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

BACKGROUND: Extremely preterm infants represent one of the highest risk categories for impairments in social competence. Few studies have explored the impact of the neonatal intensive care unit (NICU) environment on social development. However, none have specifically analyzed the effects of the care structure the infant receives during hospitalization on later social competence indicators. OBJECTIVE: To identify associations between the care structures received by extremely preterm infants in the NICU and scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) post-discharge. PARTICIPANTS: 50 extremely preterm infants (mean gestational age: 25 weeks during hospitalization; mean chronological age during follow-up assessment: 2 years, 4 months). METHODS: A secondary analysis of BITSEA data was performed exploring its relation to care structure data we extracted from electronic medical records (i.e., how much time infants were engaged in human interaction during their first thirty days of hospitalization and what types of interaction they were exposed to). RESULTS: Extremely preterm infants spend a considerable amount of time alone during hospitalization (80%) with nursing care comprising the majority of human interaction. Infants who experienced greater human interaction scored significantly higher on the Social Competence (p = 0.01) and lower on the Dysregulation (p = 0.03) BITSEA subscales. CONCLUSION: Human interaction and isolation in the NICU is associated with social competence and dysregulation outcomes in extremely preterm infants. Further research is needed to understand how various NICU care structures including centralized nursing teams, parental skin-to-skin care, and early therapy may synergistically play a positive role in developing social competence.

Inosine: alternative or adjunct to regional hypothermia in the prevention of post-ischemic renal failure?

Inosine administered into the renal artery improves renal ischemic tolerance. The study was designed to establish the limitations of this measure by comparing its effectiveness with that of regional hypothermia and to test the possibility of combining inosine and hypothermia in prolonged renal hypothermia. In uninephrectomized dogs, the remaining kidney was subjected to 2 h of ischemia under inosine protection; perfusion cooling, or no protection (experiment A), or to 90 min of warm ischemia plus inosine plus 90 min of cold ischemia; 90 min of warm plus 90 min of cold ischemia, or 180 min of cold ischemia (experiment B). Whereas perfusion cooling reliably prevented permanent loss of renal function even after 180 min of ischemia, inosine was clearly inadequate for protection against warm ischemia exceeding 90 min, but effective in shorter periods of ischemia with some unreliability in borderline cases. Inosine protection can be combined with hypothermia in a sequential manner if extended ischemia becomes necessary unexpectedly. For clinical use, however, it seems safer to commence with hypothermia after 60 min of inosine-protected warm ischemia. Simultaneous balloon occlusion of the renal artery and transcatheter perfusion cooling facilitates the clinical applicability of these results.