This is a Shannon award providing partial support for the research projects that fall short of the assigned Institute's funding range but are in the margin of excellence. The Shannon award is intended to provide support to test the feasibility of the approach; develop further tests and refine research techniques; perform secondary analysis of available data sets; or conduct discrete projects that can demonstrate the PI's research capabilities or lend additional weight to an already meritorious application. The abstract below is taken from the original document submitted by the principal investigator. DESCRIPTION: (Adapted from applicants abstract) Infants on mechanical ventilation (MV) are often agitated. Methods of care that conserve energy and calm these infants are needed to optimize ventilation and pulmonary functioning. An established intervention called kangaroo care (KC), skin-to-skin contact between mother and preterm infant, increases body warmth within neutral thermal zone, calms infants so crying and purposeless activity is minimal, doubles quiet sleep frequency and duration, and reduces incidence of apnea by 75%. KC is now being proposed with critically ill infants who require mechanical ventilation. The purposes of this study are to determine the safety of KC by examining cardiorespiratory, thermal and selected pulmonary function outcomes of its use, and to determine if pulmonary function benefits are present in mechanically ventilated infants. Comparisons of these values to pre-KC, post-KC and to control group findings will be made. KC will be given for one hour on each of 4 days of mechanical ventilation, starting with the second day of mechanical ventilation. The design is a randomized controlled clinical trial of 20 Control and 40 KC infants with continuous, real time testing of heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), abdominal temperature (AT), back temperature (BT), C20/C dynamic compliance, resistance of airway on expiration, minute ventilation, mean airway pressure, and tidal CO2, FiO2 level, and the number of apnea episodes for a one hour pretest, one hour test, and one hour posttest period on each day for all subjects. Infants will be placed on the INFANT STAR sync ventilator lying prone and flexed within an OHIO IC incubator with a rolled blanket forming a boundary around the infant across the head, one side, and the feet. Control group infants will remain in this position for each of the three consecutive periods each day of the study. During KC, infants will be placed semi-upright against the mother's chest. The Gould Physiograph Recorder will record, and store at 10Hz, the HR, RR, SaO2, AT, BT; the BICORE CP100 will detect, record, and store the pulmonary measures that are updated with each breath; the COSMO will detect, record, and store end tidal CO2 values that are updated with each breath. Behavioral state will be observed each minute using the Anderson Behavioral State Scoring system; apnea frequency will be determined by two certified neonatal pneumographers who independently score pneumograms recorded by the Gould Physiograph Recorder. Continuous data will be analyzed using repeated measures analysis of variance. To demonstrate safety the hypothesis is that KC infants will demonstrate values within clinically acceptable range during the KC period similar to those derived from the pre- and post-KC periods and from control infants. To demonstrate benefits the hypothesis is that KC infants will have more optimal values within clinically acceptable ranges compared to control infants and their own preKC and postKC values for SaO2, FiO2 levels, end tidal CO2, and more quiet regular sleep and fewer apneic episodes. If these hypotheses are upheld adaptation of KC as an intervention that is safe with these critically ill infants is possible; if benefits to ventilation exist, future study examining KCs effect on length of ventilation and progression to bronchopulmonary dysplasia and chronic lung diseases can be tested.
