Individual consistency in behavioral states in neonates

Abstract

In this study we identified consistent characteristics of the sleep-wake state of newborn infants.Forty-one normal, full-term infants were observed in a warmer-skin temperature maintained at 36.1"C-located in a sound-attenuated room for 1 hr during 2 successive mid-feeding periods. The infant's state was recorded on a check-list every 10 see using the following categories for sleep and wakefulness: Quiet Sleep A , Quiet Sleep B , Active Sleep Without REM, Active Sleep With REM, Active Sleep With Dense REM, Drowsy, Alert Inactivity, Waking Activity, Fussing, Crying, and Indefinite State. Immediately following the completion of each observation, the 2 observers made independent judgments of the degree of organization shown by the infant, using a 6-point scale.Over the two 1-hr observations, only Quiet Sleep A . Quiet Sleep B , and Crying showed any consistency. Active Sleep as typically defined showcd no consistency whatsoever. However. 2 of thc 3 components of Active Sleep wrrc significantly reliable measures for the 2 observations; in sleeping infants all 3 components of active sleep showed high reliability. These results indicate that Active Sleep may be a composite of at least 3 meaningful categories.To look at overall state organization in the neonate, including both sleep and wake states, we considered Active Slecp as 3 separate states and then combined the resulting 11 behavioral states into derived clusters such that each combination of states showed a test-retest reliability above .52. With these 5 state clucters we viewed each infant's state behaviors in terms of a profile depicting the percent of time qpent in each state cluster. We found a close association between these profiles and the wbjectivc judgments of sleep-wake state organization made by the observers.The results clcarly indicate that a 1 -hr observation provides reliable information on individual sleep-wake states in the newborn.A reliable description of t h e behavioral states in a neonate should provide a basic p i c t u r e of the infant's earliest behavioral organization. Behavioral states are assumed to reflect underlying neuroph ysiological processes, as the categories of states are correlated w i t h p a t t e r n i n g of physiological measures including the electroencephalogram (EEG). heart r a t e , respiration, and the electromyogram (Prechtl, 1968; S t e r n , Parnielee, Akiyama, Schultz, & W e n n e r , 1969). Changes w i t h age in neurological d e v e l o p m e n t as indicated by EEG patterns and other measures of central nervous m a t u r a t i o n are accompanied by changes in behavioral state characteristics (Petre-Quadens, DeLec, & Rerny, 1971).

Oral Feeding Competences of Healthy Preterm Infants: A Review

“…Alertness is a behavioural state in the normal newborn that is critical to interaction with the environment and has been linked to later cognitive learning and development [26–29]. Typically, caregivers determine oral feeding readiness based on physiologic indicators such as successful weight gain and respiratory stability [30–32]. Postmenstrual age (PMA) or behavioural maturation is often only considered after these other indicators have been satisfied.…”

Biobehavioral State and Orienting: Implications for Educating Profoundly Retarded Students

“…Arousal theory also made the infant's sleep-wake pattern dependent upon environmental stimuli. In the normal neonate, however, sleep-wake patterns have a consistent proportional relationship with one another (Thoman, Korner, & Kraemer, 1976) indicative of an underlying organization of the central nervous system.…”

Preterm infants’ orally directed behaviors and behavioral state responses to the integrated H-HOPE intervention

“…Seven categories of behavioral state (quiet sleep, active sleep, sleep-wake transition, drowsy, alert, non-alert waking activity, and crying) developed by Thoman and modified by Holditch-Davis (Holditch-Davis & Thoman, 1987; Thoman, 1987, 1990; Thoman et al, 1985; Thoman, Korner, & Kraemer, 1976) were studied. These categories exhibit reliable individual differences and accurately profile the behavioral states of young preterm infants during the neonatal period (Holditch-Davis & Edwards, 1998a, 1998b).…”