Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative.

Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

BACKGROUND: Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. PURPOSE: This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. METHODS: The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. RESULTS: Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. IMPLICATIONS FOR PRACTICE: Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. IMPLICATIONS FOR RESEARCH: Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

Iron-catalyzed intermolecular [2π+2π] cycloaddition.

The bis(imino)pyridine iron dinitrogen compounds, ((iPr)PDI)Fe(N(2))(2) and [((Me)PDI)Fe(N(2))](2)(µ(2)-N(2)) ((R)PDI = 2,6-(2,6-R(2)-C(6)H(3)N═CMe)(2)C(5)H(3)N; R = (i)Pr, Me), promote the catalytic intermolecular [2π + 2π] cycloaddition of ethylene and butadiene to form vinylcyclobutane. Stoichiometric experiments resulted in isolation of a catalytically competent iron metallocycle intermediate, which was shown to undergo diene-induced C-C reductive elimination. Deuterium labeling experiments establish competitive cyclometalation of the bis(imino)pyridine aryl substituents during catalytic turnover.

Synthesis, electronic structure, and catalytic activity of reduced bis(aldimino)pyridine iron compounds: experimental evidence for ligand participation.

The two-electron reduction chemistry of the aryl-substituted bis(aldimino)pyridine iron dibromide, ((iPr)PDAI)FeBr(2) ((iPr)PDAI = 2,6-(2,6-(i)Pr(2)-C(6)H(3)-N═CH)(2)C(5)H(3)N), was explored with the goal of generating catalytically active iron compounds and comparing the electronic structure of the resulting compounds to the more well studied ketimine derivatives. Reduction of ((iPr)PDAI)FeBr(2) with excess 0.5% Na(Hg) in toluene solution under an N(2) atmosphere furnished the η(6)-arene complex, ((iPr)PDAI)Fe(η(6)-C(7)H(8)) rather than a dinitrogen derivative. Over time in pentane or diethyl ether solution, ((iPr)PDAI)Fe(η(6)-C(7)H(8)) underwent loss of arene and furnished the dimeric iron compound, [((iPr)PDAI)Fe](2). Crystallographic characterization established a diiron compound bridged through an η(2)-π interaction with an imine arm on an adjacent chelate. Superconducting quantum interference device (SQUID) magnetometry established two high spin ferrous centers each coupled to a triplet dianionic bis(aldimino)pyridine chelate. The data were modeled with two strongly antiferromagnetically coupled, high spin iron(II) centers each with an S = 1 [PDAI](2-) chelate. Two electron reduction of ((iPr)PDAI)FeBr(2) in the presence of 1,3-butadiene furnished ((iPr)PDAI)Fe(η(4)-C(4)H(6)), which serves as a precatalyst for olefin hydrogenation with modest turnover frequencies and catalyst lifetimes. Substitution of the trans-coordinated 1,3-butadiene ligand was accomplished with carbon monoxide and N,N-4-dimethylaminopyridine (DMAP) and furnished ((iPr)PDAI)Fe(CO)(2) and ((iPr)PDAI)Fe(DMAP), respectively. The molecular and electronic structures of these compounds were established by X-ray diffraction, NMR and Mössbauer spectroscopy, and the results compared to the previously studied ketimine variants.

Synthesis of aryl-substituted bis(imino)pyridine iron dinitrogen complexes.

The synthesis and characterization of dimeric, aryl-substituted bis(imino)pyridine iron dinitrogen complexes is described. In contrast to reduction with sodium amalgam where bis(chelate) iron compounds were isolated, stirring ((Ar)PDI)FeBr(2) or ((Me)BPDI)FeBr(2) (PDI = 2,6-(ArN=CMe)(2)C(5)H(3)N; Ar = 2,6-Et(2)-C(6)H(3)N ((Et)PDI), 2,6-Me(2)-C(6)H(3)N ((Me)PDI), 2-(i)Pr,6-Me-C(6)H(3)N ((Me,iPr)PDI); (Me)BPDI = 2,6-(2,6-Me(2)-C(6)H(3)N=CPh)(2)C(5)H(3)N) with sodium naphthalenide resulted in isolation of the desired iron dinitrogen compounds as diamagnetic solids. Two examples, [((Et)PDI)Fe(N(2))](2)(mu(2)-N(2)) and [((Me)BPDI)Fe(N(2))](2)(mu(2)-N(2)), were characterized by X-ray diffraction. The solid state metrical parameters, in combination with infrared and Mossbauer spectroscopic data, establish ferrous compounds with doubly reduced chelates. Each new bis(imino)pyridine iron dinitrogen compound was screened for the catalytic hydrogenation of ethyl-3-methylbut-2-enoate, and the compound bearing the smallest aryl substituent, [((Me)PDI)Fe(N(2))](2)(mu(2)-N(2)), offers significant improvement over the original ((iPr)PDI)Fe(N(2))(2) pre-catalyst and is one of the most active iron pre-catalysts known.

N-N bond cleavage in diazoalkanes by a bis(imino)pyridine iron complex.

Addition of monosubstituted diazoalkanes, N(2)CHR (R = Ph, p-Tolyl, (t)Bu, Cy), to the bis(imino)pyridine iron dinitrogen complex, ((iPr)PDI)Fe(N(2))(2), at 23 degrees C in benzene-d(6) resulted in rapid cleavage of the N-N bond to yield the iron nitrile and imine complexes, ((iPr)PDI)FeNCR and ((iPr)PDI)FeHNCHR, respectively. Aryl azines were also cleaved with ((iPr)PDI)Fe(N(2))(2) and yielded the same products. Mechanistic studies support a pathway involving initial formation of an iron alkylidene followed by rapid [4pi + 2pi] cycloaddition with another equivalent of diazoalkane. Subsequent rate-determining 1,3-hydrogen migration followed by retrocycloaddition yields the observed products.