443 - Effects of Kangaroo Care on Neuro-Cardiorespiratory Measures in Preterm Neonates

Publication Number: 3428.443

Sofia V. Zitella, Northwestern University The Feinberg School of Medicine, Long Grove, IL, United States; Kiana Mohammadian, Northwestern University Department of Biomedical Engineering, Naperville, IL, United States; Deeb Omari, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; John M. Perry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Yayun Du, Vanderbilt University, Nashville, TN, United States; Gustave H. Falciglia, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Andrea C.. Pardo, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; john Rogers, Northwestern University The Feinberg School of Medicine, evanston, IL, United States; Susan M. Slattery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Preterm infants exhibit immature cortical and cardiorespiratory activity. Kangaroo Care (KC), skin-to-skin contact between parent and infant, promotes autonomic stability, supports neurological maturation, and is associated with improved long-term neurodevelopmental outcomes. Immediate neurophysiologic effects of KC remain unexplored because traditional wired amplitude-integrated electroencephalography (aEEG) prevents continuous recording.

Objective: To characterize real-time neuro-cardiorespiratory responses to KC in preterm infants using novel wireless aEEG and bioelectric sensors.

Design/Methods: Stable infants (32-35 weeks corrected gestational age; chronological age 1-4 weeks) without respiratory support or <= 2 LPM HFNC were monitored at a Level III NICU. Wireless aEEG and a chest sensor recorded cortical and cardiorespiratory data at rest (baseline) and during KC (each >1 hour) (Figure 1). aEEG parameters included inter-burst intervals (IBIs), spectral edge frequency (SEF), and amplitude margins, classified as either discontinuous normal voltage or continuous normal voltage (CNV) (Hellström-Westas, 2006). Physiologic metrics included heart rate (HR), high and low frequency HR variability (HF HRV, LF HRV), bradycardias, respiratory rate (RR), and RR variability (RRV). Per-patient medians were averaged for baseline and KC and compared using Wilcoxon signed-rank test.

Results: Sensors captured data safely and effectively in a preliminary pilot of seven infants (Table 1). No metrics reached statistical significance when comparing baseline and KC, but trends indicated increased parasympathetic tone and more mature aEEG patterns during KC (Figure 2). Specifically, during KC, aEEG was more continuous, IBIs were compressed (shorter, less percent time), and SEF and lower margin amplitude increased. The background moved toward CNV during KC (Hellström-Westas, 2006). In parallel, KC was associated with higher RR / HR and fewer bradycardias.

Conclusion(s): Although statistical significance was not achieved, our study demonstrated feasibility of wireless neuro-cardiorespiratory monitoring during KC in premature infants. Wireless aEEG enables continuous monitoring during KC and reveals trends toward immediate cortical activation with improved parasympathetic regulation. Ongoing data collection will clarify and strengthen our hypothesis that KC promotes neurophysiologic maturation.

Table 1. aEEG and Cardiorespiratory Measures at Rest vs During Kangaroo Care (n = 7)
Results of aEEG and cardiorespiratory metrics during baseline vs KC, including categorical amplitude classification according to Hellström-Westas aEEG classification methods.

Figure 1. Placement of Wireless aEEG
3 channel wireless aEEG placed on infant scalp with NuPrep gel (Weaver and Co., Aurora, CO) and Pulse Oximetry Tape (left) with wireless body sensor placed on infant chest with pulse oximetry tape (right).

Figure 2. Bi-Frontal aEEG Waveform during Rest vs KC from single premature patient
aEEG from a 34w 4d male neonate with frontal electrodes during rest (blue) and KC (orange). KC shows increased continuity (lower margin >5 µV), with a more mature, continuous pattern compared to rest. Semilogarithmic scale; amplitudes >10 µV are logarithmic.