title: Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments.
abstract: OBJECTIVE
  To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology, and brain structure at hospital discharge; and developmental outcomes at 2 years of age.
  
  
  METHODS
  In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at 2 years of age (n = 86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were: (1) medical factors throughout the hospitalization; (2) neurobehavior; and (3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography).
  
  
  RESULTS
  At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores (P = .02; β = -0.52 [CI -0.95, -0.10]). At age 2 years, infants from private rooms had lower language scores (P = .006; β = -8.3 [CI -14.2, -2.4]) and a trend toward lower motor scores (P = .02; β = -6.3 [CI -11.7, -0.99]), which persisted after adjustment for potential confounders.
  
  
  CONCLUSIONS
  These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO; Department of Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: Pineda_r@kids.wustl.edu.
authors.forename: Roberta G
authors.initials: RG
authors.lastname: Pineda
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO; Department of Radiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Jeff
authors.initials: J
authors.lastname: Neil
authors.affiliation: Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Donna
authors.initials: D
authors.lastname: Dierker
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Smyser
authors.affiliation: Department of Biostatistics, Washington University School of Medicine, St Louis, MO.
authors.forename: Michael
authors.initials: M
authors.lastname: Wallendorf
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Reynolds
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Walker
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rogers
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Mathur
authors.affiliation: Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO.
authors.forename: David C
authors.initials: DC
authors.lastname: Van Essen
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO; Department of Radiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Terrie
authors.initials: T
authors.lastname: Inder
mesh_terms: D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D002657:Child Development; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D004569:Electroencephalography; D004781:Environmental Exposure; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D011379:Prognosis; D011446:Prospective Studies
keywords: Amplitude integrated electroencephalography; Bayley Scales of Infant and Toddler Development, 3rd edition; Bayley-III; CRIB; Critical Risk Index for Babies; Echo time; FA; FAD; Fractional anisotropy; Functional connectivity magnetic resonance imaging; ITSEA; Infant Toddler Social Emotional Assessment; M-CHAT; MRI; Magnetic resonance imaging; McMaster Family Assessment Device; Modified Checklist for Autism in Toddlers; NICU; NICU Network Neurobehavioral Scale; NNNS; Neonatal intensive care unit; PDA; PMA; Patent ductus arteriosus; Postmenstrual age; Repetition time; TE; TR; aEEG; fcMRI