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Temporary skin-to-skin contact between preterm infant and the mother is increasingly used in neonatal medicine to promote bonding. It is not known at which gestational age (GA) and postnatal age skin-to-skin contact outside the incubator is a sufficiently warm environment and is tolerated by preterm infants without a decrease in body temperature, oxygen consumption (VO2) increase, or unrest. We conducted a prospective clinical study of 27 spontaneously breathing preterm infants of 25-30-wk GA. Rectal temperature (Trecta), VO2 (indirect calorimetry), and activity were continuously measured in the incubator (60 min), during skin-to-skin contact (60 min), and back in the incubator (60 min) in wk 1 and 2 of life. In wk 1 the change in Trectal during skin-to-skin contact was related to GA (r=0.585, p=0.0027): infants of 25-27-wk GA lost heat during skin-to-skin contact, whereas infants of 28-30 wk gained heat and their mean Trectal during skin-to-skin contact was 0.3 degrees C higher than before (p < 0.01). No significant changes of VO2 or activity occurred. In wk 2 the infants' VO2 was higher than in wk 1, but VO2 during skin-to-skin contact was the same as in the incubator. Only small fluctuations in Trectal occurred. In wk 2 all infants slept more during skin-to-skin contact than in the incubator (p < 0.02). We conclude that, for preterm infants of 28-30-wk GA, skin-to-skin contact was a sufficiently warm environment as early as postnatal wk 1. For infants of 25-27-wk GA skin-to-skin contact should be postponed until wk 2 of life, when their body temperature remains stable and they are more quiet during skin-to-skin contact than in the incubator.

Complete sampling of expired air is essential for accurate O2 consumption(CO2 production) [VO2(VCO2)] measurements with flow-through indirect calorimetry. In preterm infants complete sampling is critical, because only low sampling flows can be used. The accuracy of the various breath sampling systems at low flows and their patient compatibility is untested. We therefore measured 1) the accuracy of VO2(VCO2) measurements with a face mask, a head hood, and a canopy in vitro at low sampling flows; 2) the effect of breathing on measurements with the face mask; and 3) the effect of breath sampling systems on activity and body temperature of preterm infants. VO2(VCO2) were measured with a Deltatrac II. In vitro we used a methanol miniburner incorporated into a doll, which could simulate low VO2(VCO2) and tidal breathing. In vivo we studied seven preterm infants < 1500 g. With the face mask VO2(VCO2) measurements were accurate at a flow of 3 L/min (error -1 +/- 0.8%), when tidal volume was < 15 mL/breath and the distance between mask and manikin < 1 cm. With hood and canopy VO2(VCO2) were underestimated at a flow of 3 L/min (error -13 +/- 1% and -14 +/- 5%), and results were markedly influenced by body position. For accurate measurements, the hood needed a flow of 4.5 L/min, the canopy 8.3 L/min. In vivo the face mask did not increase heart rate, respiration, activity, or rectal temperature, but hood and canopy increased rectal temperature by 0.3-0.4 degree C. For VO2(VCO2) measurements in infants < 1500 g, a face mask should be used, which is accurate at low flows and does not change body temperature. Accuracy at low flows and patient compatibility of breath sampling systems should be evaluated and reported for VO2(VCO2) measurements in preterm infants.

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Purpose To poll sports concussion specialists regarding most frequently used criteria for determination of concussion recovery. Methods Seventy-four participants responded to a survey including 17 items regarding clinical recovery from concussion in youth and adults. Overall, 69 reported treating patients with sports concussion, meeting criteria for inclusion (92.8% white, 53.6% male). Participants included neuropsychologists (n=35), certified athletic trainers (n=30), physicians (n=3), and one physical therapist who rated (1=Not Important; 5=Essential) clinical criteria for concussion recovery decisions. Results For youth, the majority of participants provided the highest “Essential” modal rating for all six criteria: Normal visual/ocular motor testing; non-contact physical exertion without symptoms; completion of graded return-to-play protocol; full day of school without symptoms; no concerns in physician exam; no fear/avoidance/anxiety in return to sport. For adults, highest model ratings included seven items: participation in non-contact exertion without symptoms; passed formal physical exertional testing; completion of graded return to play protocol; completion of full day of work/school without symptoms; physician exam with no concerns; no report of fear/avoidance/anxiety regarding return to sport; athlete reports feeling 100% back to normal. In adults, 79% indicated one week of no symptoms was sufficient to help indicate recovery and 75% indicated so for youth. For youth and adults, 56% of respondents endorsed use of neurocognitive testing as Essential/Very Important. Conclusions This study revealed similarity in concussion recovery decisions for adults and youth with minor differences. These results provide first steps toward documenting a template of current clinical practice for defining concussion recovery.