Sleep Rhythmicity in Premature Infants: Implications For Developmental Status

Borghese, Ilaria F.; Minard, Kathleen L.; Thoman, Evelyn B.

doi:10.1093/sleep/18.7.523

Cited by 51 publications

(27 citation statements)

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“…A study using a movement-sensitive mattress to detect staterelated movements and respiratory behaviors documented cyclicity for 20 of 49 infants using these 24-h studies by 36 wk GA (14). Thirty-seven of 42 infants of this same cohort expressed sleep cyclicity using the same method at 6 mo of age.…”

Section: Discussionmentioning

confidence: 95%

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

2005

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Previous sleep studies of preterm neonates describe the rudimentary expression of sleep state cyclicity after 30 wk postconceptional age (PCA), with stability over multiple cycles only after 36 wk PCA. The research objective for this study was to determine whether sleep state cyclicity was expressed in neonates of 25-30 wk PCA, using two criteria for state identification. Our neonatal sleep consortium includes a total cohort of 359 children who were healthy and medically ill neonates who were recruited from three obstetric-neonatal services and received multiple-hour EEG sleep studies. A subset of the 33 youngest preterm infants were selected to evaluate the first of serial 2-to 3-h EEG-sleep recordings to assess the presence of sleep state cyclicity. One neonatal neurophysiologist visually assigned EEG-sleep characteristics for each record. Rapid eye movement (REM) counts and EEG discontinuity were specifically chosen to assess whether sleep cyclicity was expressed. A combined measure of REM and EEG discontinuity were used in an autocovariance analysis to assess cycling and mean cycle duration. A mean cycle duration of 68 Ϯ 19 min with a range of 37-100 min was determined from the REM-EEG discontinuity state for 24 neonates. The remaining nine infants had absent or poor sleep cyclicity. Sleep state cyclicity is expressed for a majority of neonates between 25 and 30 wk PCA, reflecting an ultradian biologic rhythm during the early perinatal stage of brain development. (Pediatr Res 57: 879-882, 2005) Abbreviations GA, gestational age PCA, postconceptional age REM, rapid eye movement Functional brain organization can be assessed by applying analyses to EEG-sleep state architecture and continuity measures. The observation of sequentially recurring eye movement intervals alternating with no eye movement epochs was initially described in the newborn infant as early as the 1950s (1). Such a sequence suggests either the presence of a highly periodic process or, alternatively, the temporal coincidence, with variable predictability, among physiologic behaviors that sometimes define state transitions. Early investigators suggested the presence of periodicity in infant sleep measures (2,3). Sterman et al. (4) observed periodicity from early gestational ages (GAs), beginning with the basic rest-activity cycle in the fetus and the sleep cycle in infants. Globus (5) described cyclicity at all GAs, with predictable rhythmicity after 36 wk postconceptional age (PCA). Other authors stressed the clinical importance of sleep periodicity, as exemplified by reports of disturbed cyclic organization of sleep in infants with CNS disorders (6) as well as asymptomatic infants at risk for sudden infant death syndrome (7,8).Specific investigations questioned the definition of sleep state cyclicity when applying alternative methods, particularly when states were considered categorical events (5,9,10). On the basis of these specific methodologic approaches, sleep cyclicity did not appear until at least 6 wk of life (11), 4 -6 mo postnatally (...

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Section: Discussionmentioning

confidence: 95%

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

2005

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“…Sleep measures have been demonstrated to be very sensitive indices of central nervous system functional status. 9,11,[25][26][27][28] Our MMS assessment was not performed during the earlier course of the intervention; therefore, we do not have data regarding the acute effects of NIDCAP on sleep. The hypothesis that there is improved central nervous system development as measured by sleep quantity and maturation resulting from individualized developmental (NIDCAP) care was not supported by the sleep measures in this study.…”

Section: Discussionmentioning

confidence: 99%

Developmental Care Does Not Alter Sleep and Development of Premature Infants

et al. 1997

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ABSTRACT. Objective. The Neonatal Individualized Developmental Care Program (NIDCAP) for very low birth weight (VLBW) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator, time to nipple feed, the duration of hospital stay, better behavioral performance on Assessment of Preterm Infants' Behavior (APIB), and improved neurodevelopmental outcomes. We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern, behavioral, and neurodevelopmental outcome.Methods. Thirty-five VLBW infants were randomly assigned to receive NIDCAP or routine infant care. The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by: a) altering the environment by decreasing excess light and noise in the neonatal intensive care unit (

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“…Sleep-wake measures during the preterm period-including the amount of crying, sleep cycle length, state organization quality, and amount of night sleep-predict Bayley scores during the first year (Borghese, Minard, & Thoman, 1995;DiPietro & Porges, 1991;Fajardo, Browning, Fisher, & Paton, 1992;Gertner et al, 2002). Developmental changes in the amounts of specific sleep behaviors during the first year are related to outcomes in the second year (Anders, Keener, & Kraemer, 1985;Whitney & Thoman, 1993).…”

Section: Introductionmentioning

confidence: 99%

Prediction of 3-year developmental outcomes from sleep development over the preterm period

Holditch‐Davis

Belyea

Edwards

2005

Infant Behavior and Development

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This study explored whether the developmental status of 3-year-old prematurely born children could be predicted from the development of sleep-wake behaviors during the preterm period. Sleep-wake states were observed weekly in 71 preterms from the time they were no longer critically ill until term or discharge, and the general linear mixed model was used to model the development of preterm behaviors for both individuals and the group. At 3 years, the home environment and developmental status of 51 children was assessed. Individual infants' deviations from group slopes and intercepts of eight preterm sleep variables were used as predictors. Cluster analyses of the predictor variables were found to relate to Stanford-Binet IQ, language, and fine and gross motor abilities at 3 years post-term. Children in Cluster 4, which showed more rapid active sleep development, averaged higher IQs and better language and fine motor abilities than children in other clusters.

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Sleep Rhythmicity in Premature Infants: Implications For Developmental Status

Cited by 51 publications

References 0 publications

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age

Developmental Care Does Not Alter Sleep and Development of Premature Infants

Prediction of 3-year developmental outcomes from sleep development over the preterm period

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