Preterm Infant Development

Adolescent Development Study

This prospective longitudinal investigation is one of a few in which the course of competence outcomes have been examined in children born at various degrees of perinatal morbidity.  With rising number of preterm infant survivors, it serves as a model to understand how preterm infants born today will do when they reach late adolescence.  This study, inclusive from birth to age 17, will provide a comprehensive understanding of specific developmental trajectories, and risk and protective processes that exacerbate or ameliorate the impact of cumulative risk on competency outcomes in full term and preterm children.  The ultimate reason to understand the trajectories of long term outcomes is identification of possibilities for preventative interventions.  Formulating a science of prevention requires attention to complex interactions between children and their contexts across periods of time.  For more information contact:  Mary Sullivan at MCSullivan@uri.edu.

MRI/fMRI and Kinematics in Preterm Infants

We use Magnetic Resonance Imaging (MRI) and Functional Magnetic Resonance Imaging (fMRI) to detect structural abnormalities in brain motor areas and differences in neuroactivation during motor tasks in children with poor motor performance and suspected brain pathology due to perinatal.  The research protocol is designed to acclimate children of a wide age range to the Magnetic Resonance system in a developmentally appealing paradigm adjusted for complexity by using nearly identical visual motor and kinematic assessment in a pre-MR session that are repeated in the magnet in an expanded visual-spatial task.  Kinematic analysis provides a precise measure of the position of the moving limb in 3-dimensional space at all points during the reach, generating parameters that relate to the efficiency of the reaching process.  This is a new application of kinematic analysis which is particularly relevant to this project because it is sensitive to perinatal insult or residual brain damage in children and adolescents, particularly those with subsequent motor diagnoses; and, kinematic parameters are sensitive to cognitive load, which may be more compromised in children with deficits in visual-motor integration.  Motor planning and execution of a directed reach includes processing information (e.g., attention, discrimination), localization of target, and implementation of the reach by muscles and joints.  The kinematic assessment is being done in collaboration with Dr. LaGasse at the Center.  This project also includes collaboration with the University of Rhode Island and the Brown University MR Facility.  For more information contact: Mary Sullivan at MCSullivan@uri.edu .

Effects of Open-Bay vs. Single Room NICU on Infant Outcomes at Discharge

Prematurity is an increasing public health concern as the rate of prematurity in the U.S. is on the rise. Efforts to improve preterm infant outcomes include environmental stimulation (sound and light), psychosocial factors, developmental care, family centered care and staff behavior and attitudes. Women and Infants Hospital is building a new NICU with 70 individual single rooms. The “single family room” model of care is one of the environments thought to enhance medical and developmental outcomes. The single room concept is attractive because factors that adversely affect the infant can be better controlled, patient care can be individualized and parent satisfaction can be improved. However, nearly all of the evidence is anecdotal. This study aims to compare the medical and neurodevelopmental course from birth through discharge from the NICU between infants in the current open bay nursery with infants in the new single room nursery. This provides an exciting one-time opportunity to conduct a naturalistic study and compare infant outcome in the current open bay nursery with the outcome of infants in the coming single room nursery. Our plan is to study virtually all infants in the NICU, with birthweight <1500 gms, for four consecutive years, two years before and two years after the move to the new NICU. We hypothesize that infants in the single room NICU will have better medical and neurobehavioral outcomes at discharge than infants in the open bay NICU. Medical outcomes include length of stay, gestational age at discharge, weight, weight gain, illness severity and resource utilization, gestational age at enteral feeding, sepsis and necrotizing enterocolitis. Neurobehavioral outcomes include better NICU Network Neurobehavioral Scale (NNNS) profiles, better sleep state organization and sleep physiology, better infant mother feeding interaction scores and lower pain scores. We also hypothesize that the positive effects of the new NICU will be explained in part by other mediating factors that can be expected to co-occur with the transition to the new NICU. These factors include changes in family centered care, developmental care, parenting and family factors, staff behavior and attitudes and changes in medical practice. These factors will be measured repeatedly before and after the move to the new NICU and used as mediators in the statistical analysis. Findings from this study will likely influence the future quality of NICU design and model of care throughout the Nation. For more information contact: Katheleen Hawes at 453-7635 or khawes@wihri.org.