Sleeping and waking state development in preterm infants.

BACKGROUND Most studies of sleep-wake states of preterm infants have been cross-sectional. Thus, the extent to which sleep-wake development occurs within individuals and how environmental factors affect the development of sleeping and waking is unclear. AIMS This study examined the development of sleeping and waking during the preterm and early post-term periods and the effects of infant health and environmental characteristics. DESIGN Longitudinal, descriptive design. PARTICIPANTS 134 preterm infants at high risk for developmental problems because of birthweights under 1500 g or mechanical ventilation. OUTCOME MEASURES Weekly 2-h behavioral observations were conducted from the time infants were no longer critically ill until 43 weeks post-conceptional age or discharge. A single follow-up observation was conducted 1-3 months later. RESULTS Active sleep, large body movements and the percent of no REM during active sleep decreased with age, and quiet waking, active waking, quiet sleep and regularity of respiration in active sleep and quiet sleep increased. The state of sleep-wake transition increased until 40 weeks and then decreased after 43 weeks CA. Negative facial expressions showed a quadratic decrease over age. Active waking, active sleep, negative facial expressions and quiet sleep regularity showed a change of development after term. Infant characteristics, illness severity and medical treatments, the handling due to performing an EEG and hospital had only minor effects. CONCLUSIONS Significant development of sleeping and waking occurs over the preterm period. Additional research is needed to determine how the change from the hospital to the home environment affects on these developmental trajectories.

[1]  J. Ardura,et al.  Development of sleep–wakefulness rhythm in premature babies , 1995, Acta paediatrica.

[2]  S. Porges,et al.  Behavioral sleep states in very low birth weight preterm neonates: relation to neonatal health and vagal maturation. , 1996, Journal of pediatric psychology.

[3]  D. Gozal,et al.  Effect of supplemental oxygen on sleep architecture and cardiorespiratory events in preterm infants. , 2002, Pediatrics.

[4]  W. Fifer,et al.  Methodological issues in coding sleep states in immature infants. , 1995, Developmental psychobiology.

[5]  J. Piva,et al.  [Eyes on the present and looking into the future] , 2001, Jornal de pediatria.

[6]  M. Blumberg,et al.  A developmental and component analysis of active sleep. , 1996, Developmental psychobiology.

[7]  A. H. Parmelee,et al.  Sleep States in Premature Infants , 1967, Developmental medicine and child neurology.

[8]  M. Mirmiran,et al.  Developmental care does not alter sleep and development of premature infants. , 1997, Pediatrics.

[9]  L. Curzi-Dascalova,et al.  Sleep organization is unaffected by caffeine in premature infants. , 2002, The Journal of pediatrics.

[10]  Todd Schwartz,et al.  Development of Behaviors in Preterm Infants: Relation to Sleeping and Waking , 2003, Nursing research.

[11]  P. Peirano,et al.  Development of sleep states in normal premature and full-term newborns. , 1988, Developmental psychobiology.

[12]  L. Edwards Modern statistical techniques for the analysis of longitudinal data in biomedical research , 2000, Pediatric pulmonology.

[13]  B. Taylor,et al.  Factors Affecting Heart Rate Variability and Heart Rate Responses to Tilting in Infants Aged 1 and 3 Months , 2000, Pediatric Research.

[14]  R. Jennrich,et al.  Unbalanced repeated-measures models with structured covariance matrices. , 1986, Biometrics.

[15]  K. Strongman,et al.  The organization and stability of sleep states in in fullterm, preterm, and small-for-gestational-age infants: a comparative study. , 1985, Developmental psychobiology.

[16]  D. Holmes Early influences of prematurity, illness, and prolonged hospitalization on infant behavior. , 1982 .

[17]  Avi Sadeh,et al.  Sleep-wake patterns in preterm infants and 6 month's home environment: implications for early cognitive development. , 2002, Early human development.

[18]  W. Maclean,et al.  Infant sleep-wake characteristics: relation to neurological status and the prediction of developmental outcome , 1995 .

[19]  R. V. Oostenbrugge,et al.  State profile in low-risk pre-term infants: A longitudinal study of 7 infants from 32–36 weeks of postmenstrual age , 1992, Brain and Development.

[20]  J. Orem Medullary respiratory neuron activity: relationship to tonic and phasic REM sleep. , 1980, Journal of applied physiology: respiratory, environmental and exercise physiology.

[21]  G. Anderson,et al.  Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week. , 2002, Journal of advanced nursing.

[22]  G. Holmes,et al.  Central nervous system maturation in the stressed premature , 1979, Annals of neurology.

[23]  E. Thoman,et al.  Sleep in premature and fullterm infants from 24-hour home recordings☆ , 1994 .

[24]  R. J. Thompson,et al.  Nursery Neurobiologic Risk Score: Levels of Risk and Relationships with Nonmedical Factors , 1993, Journal of developmental and behavioral pediatrics : JDBP.

[25]  M. Vecchierini,et al.  Patterns of EEG Frequency, Movement, Heart Rate, and Oxygenation after Isolated Short Apneas in Infants , 2001, Pediatric Research.

[26]  Behavioral State as a Lead Variable in Neonatal Research. , 1987 .

[27]  D. Stevenson,et al.  State behavior of preterm infants as a function of development, individual and sex differences , 1988 .

[28]  L M Dubowitz,et al.  Clinical assessment of gestational age in the newborn infant. , 1970, The Journal of pediatrics.

[29]  B. J. Myers,et al.  Prematurity and respiratory illness : Brazelton scale (NBAS) performance of preterm infants with bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), or no respiratory illness , 1992 .

[30]  D. Holditch-Davis The development of sleeping and waking states in high-risk preterm infants☆ , 1990 .

[31]  K. Muller,et al.  Linear Equality Constraints in the General Linear Mixed Model , 2001, Biometrics.

[32]  C. Eckerman,et al.  Social stimulation and the regulation of premature infants' state prior to term age , 1988 .

[33]  H. Leonard,et al.  Sleep states and behavior patterns in preterm and fullterm infants. , 1980, Neuropediatrics.

[34]  J. Ware,et al.  Random-effects models for longitudinal data. , 1982, Biometrics.

[35]  G. Richardson,et al.  Sleep architecture and continuity measures of neonates with chronic lung disease. , 1992, Sleep.

[36]  J. Leeper,et al.  Physiologic and behavioral effects of gentle human touch on preterm infants. , 2000, Research in nursing & health.

[37]  M. Scher,et al.  Maturation of Phasic and Continuity Measures during Sleep in Preterm Neonates , 1994, Pediatric Research.

[38]  L. Edwards,et al.  Temporal organization of sleep-wake states in preterm infants. , 1998, Developmental psychobiology.

[39]  J. F. Peters,et al.  Development of EEG and daytime sleep patterns in low risk premature infants during the first year of life: longitudinal observations. , 1980, Electroencephalography and clinical neurophysiology.

[40]  R J Sclabassi,et al.  Maturational trends of EEG-sleep measures in the healthy preterm neonate. , 1995, Pediatric neurology.

[41]  E. Thoman,et al.  Behavioral states of premature infants: implications for neural and behavioral development. , 1987, Developmental psychobiology.

[42]  D. Fairclough,et al.  A mixed linear model with linear covariance structure: a sensitivity analysis of maximum likelihood estimators , 1986 .

[43]  L. Edwards,et al.  Modeling Development of Sleep–Wake Behaviors. II. Results of Two Cohorts of Preterms , 1998, Physiology & Behavior.

[44]  M. Eiselt,et al.  Sleep State Organization in Premature Infants of Less Than 35 Weeks' Gestational Age , 1993, Pediatric Research.

[45]  Developmental changes in phasic sleep parameters as reflections of the brain-stem maturation: polysomnographical examinations of infants, including premature neonates. , 1990, Electroencephalography and clinical neurophysiology.

[46]  C. Johnston,et al.  Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates , 1999, Neonatology.

[47]  Marie J. Hayes,et al.  Spontaneous motility in premature infants: features of behavioral activity and rhythmic organization. , 1993, Developmental psychobiology.

[48]  E. Thoman,et al.  Sleep rhythmicity in premature infants: implications for development status. , 1995, Sleep.

[49]  J. Ballard,et al.  A simplified score for assessment of fetal maturation of newly born infants. , 1979, The Journal of pediatrics.

[50]  E. Thoman,et al.  Early Sleep Patterns of Premature Infants Are Differentially Related to Later Developmental Disabilities , 1993, Journal of developmental and behavioral pediatrics : JDBP.

[51]  G Cioni,et al.  Activity patterns assessed throughout 24-hour recordings in preterm and near term infants. , 2001, Developmental psychobiology.

[52]  E. Thoman,et al.  Sleep/wake states of preterm infants: stability, developmental change, diurnal variation, and relation with caregiving activity. , 1999, Child development.

[53]  N. Rosman,et al.  Certification in child neurology by the American Board of Psychiatry and Neurology. , 1994, Pediatric Neurology.

[54]  F H Duffy,et al.  Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome. , 1986, Pediatrics.

[55]  Elizabeth M. Tornquist,et al.  Key Aspects of Caring for the Chronically Ill: Hospital and Home , 1993 .

[56]  Ramon C. Littell,et al.  SAS® System for Regression , 2001 .