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Sırtbaş-Işık G, Porsnok D, Yardımcı-Lokmanoğlu BN, Mutlu A. Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period. Sleep Med 2024; 114:151-158. [PMID: 38184924 DOI: 10.1016/j.sleep.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9-20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. METHODS Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). RESULTS The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). CONCLUSIONS Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.
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Affiliation(s)
- Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
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2
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Lewis P, Wild U, Pillow JJ, Foster RG, Erren TC. A systematic review of chronobiology for neonatal care units: What we know and what we should consider. Sleep Med Rev 2024; 73:101872. [PMID: 38000120 DOI: 10.1016/j.smrv.2023.101872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
A Cochrane 2016 review indicated cycled light might benefit neonatal health in hospital. We systematically reviewed chronobiological factors for neonatal health in hospital units, identifying 56 relevant studies on light-dark cycles, feeding, noise, massage therapy, rooming-in, incubators vs. cribs, neonatal units vs. homes, and time-of-day of birth. Empirical evidence for benefits from chronobiology is weaker than expected, including light. Mechanisms of clinical benefits are unclear (e.g., changes to sleep/activity vs. other circadian-regulated processes). Regarding light, studies concerning sleep and circadian-related outcomes predominate; yet, neonatologists may be more interested in weight gain and time spent in hospital. Generalisability of findings is limited as most studies targeted neonates in stable condition and without congenital anomalies. Further research is needed, in particular concerning potential circadian entraining signals such as timing of meals or medications. Longer-term outcomes (regarding e.g., neurodevelopment and infection), and who may be at risk from time-of-day of birth effects and why remain to be explored. Overall, there is promise and ample scope for research into how chronobiological factors affect health in hospitalised neonates.
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Affiliation(s)
- Philip Lewis
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany.
| | - Ursula Wild
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
| | - J Jane Pillow
- School of Human Sciences, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia
| | - Russell G Foster
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas C Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
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3
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Atalah YEY, Barış HE, Akdere SK, Sabancı M, Özdemir H, Gücüyener K, Eralp EE, Özek E, Boran P. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. J Clin Sleep Med 2023; 19:2075-2085. [PMID: 37559530 PMCID: PMC10692934 DOI: 10.5664/jcsm.10760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/16/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
STUDY OBJECTIVES To determine the differences in sleep patterns between preterm infants who received caffeine and those who did not and to evaluate the effects of caffeine therapy on early neurodevelopment. Secondarily, actigraphy and polysomnography were compared to evaluate the sleep of preterm infants. METHODS Twenty-eight preterm infants ages 28-34 weeks admitted to a single-center Level III neonatal intensive care unit between May 2020 and May 2021 were included. Sleep was assessed by actigraphy for 72 hours with Respironics Mini-Mitter® Actiwatch-2 and Brief Infant Sleep Questionnaire at 6 months corrected age. On the first day of actigraphy, infants underwent polysomnography between 10:00 am and 3:00 pm. Neurodevelopment was evaluated by the Bayley Scales of Infant and Toddler Development-III, the Ages & Stages Questionnaire, and the Hammersmith Infant Neurological Examination. RESULTS There were no significant differences in sleep parameters measured by actigraphy, the Brief Infant Sleep Questionnaire, and polysomnography between infants in the caffeine group (n = 12) and no-caffeine group (n = 16). Sensitivity (91.07%) and agreement rate (77.21%) for the actigraphy against polysomnography were highest at the automatic threshold. No significant differences were observed in the neurodevelopment of infants in the caffeine group compared to the no-caffeine group. CONCLUSIONS Sleep parameters and neurodevelopmental outcomes were not different in infants at 6 months of corrected age with regard to caffeine therapy. Actigraphy at the automatic threshold can be used in infants for sleep pattern assessment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Influence of Caffeine Therapy in Preterm Infants; URL: https://www.clinicaltrials.gov/ct2/show/NCT04376749; Identifier: NCT04376749. CITATION Atalah YEY, Barış HE, Akdere SK, et al. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. J Clin Sleep Med. 2023;19(12):2075-2085.
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Affiliation(s)
- Yaprak Ece Yola Atalah
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Hatice Ezgi Barış
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Selda Küçük Akdere
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Meltem Sabancı
- Marmara University, School of Medicine, Child Sleep Laboratory, Istanbul, Turkey
| | - Hülya Özdemir
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Kıvılcım Gücüyener
- Gazi University, School of Medicine, Division of Pediatric Neurology, Ankara, Turkey
| | - Ela Erdem Eralp
- Marmara University, School of Medicine, Department of Pediatrics, Division of Pediatric Pulmonology, Istanbul, Turkey
| | - Eren Özek
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Perran Boran
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
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4
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Jaeger CB, Altimier L. NICU Couplet Care: metrics to guide an evolving model of care. J Perinatol 2023; 43:30-34. [PMID: 38086964 DOI: 10.1038/s41372-023-01783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The evidence-based science of maternal and neonatal care has been rapidly changing. As a result, clinical practice and the design of physical space have evolved in order to provide neuroprotection for the baby and meet expectations of family presence and participation. SETTING The concept and practice of NICU Couplet Care supports positive health well-being/outcomes and early relationship building between the mother-baby-father/partner. RESULTS Monitoring evidence-based measures and metrics of standardized care, performance competence, neuro-physical and psychosocial outcomes, environmental design, family and staff satisfaction, and sustainability are essential to the evolution of quality, safe, efficient, effective, ethical, and cost-effective care for the mother, baby, and family. Transparency in the dissemination of evidence, practice standards, and outcome data is important to guide parents/families and health professionals in making informed shared decisions regarding the clinical care provided and the environment where care takes place.
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Affiliation(s)
- Carol B Jaeger
- Advanced Practice Nurse Programs, The Ohio State University College of Nursing, Columbus, OH, USA.
| | - Leslie Altimier
- SSM Health: Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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5
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Pineda R, Kellner P, Guth R, Gronemeyer A, Smith J. NICU sensory experiences associated with positive outcomes: an integrative review of evidence from 2015-2020. J Perinatol 2023; 43:837-848. [PMID: 37029165 PMCID: PMC10325947 DOI: 10.1038/s41372-023-01655-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
To inform changes to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, studies investigating sensory-based interventions in the NICU with preterm infants born ≤32 weeks were identified. Studies published between October 2015 to December 2020, and with outcomes related to infant development or parent well-being, were included in this integrative review. The systematic search used databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar. Fifty-seven articles (15 tactile, 9 auditory, 5 visual, 1 gustatory/olfactory, 5 kinesthetic, and 22 multimodal) were identified. The majority of the sensory interventions that were identified within the articles were reported in a previous integrative review (1995-2015) and already included in the SENSE program. New evidence has led to refinements of the SENSE program, notably the addition of position changes across postmenstrual age (PMA) and visual tracking starting at 34 weeks PMA.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Guth
- Center for Clinical Excellence, BJC HealthCare, St. Louis, MO, USA
| | | | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
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Peng Z, Kommers D, Liang RH, Long X, Cottaar W, Niemarkt H, Andriessen P, van Pul C. Continuous sensing and quantification of body motion in infants: A systematic review. Heliyon 2023; 9:e18234. [PMID: 37501976 PMCID: PMC10368857 DOI: 10.1016/j.heliyon.2023.e18234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Abnormal body motion in infants may be associated with neurodevelopmental delay or critical illness. In contrast to continuous patient monitoring of the basic vitals, the body motion of infants is only determined by discrete periodic clinical observations of caregivers, leaving the infants unattended for observation for a longer time. One step to fill this gap is to introduce and compare different sensing technologies that are suitable for continuous infant body motion quantification. Therefore, we conducted this systematic review for infant body motion quantification based on the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In this systematic review, we introduce and compare several sensing technologies with motion quantification in different clinical applications. We discuss the pros and cons of each sensing technology for motion quantification. Additionally, we highlight the clinical value and prospects of infant motion monitoring. Finally, we provide suggestions with specific needs in clinical practice, which can be referred by clinical users for their implementation. Our findings suggest that motion quantification can improve the performance of vital sign monitoring, and can provide clinical value to the diagnosis of complications in infants.
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Affiliation(s)
- Zheng Peng
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Deedee Kommers
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Neonatology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Rong-Hao Liang
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Philips Research, Eindhoven, the Netherlands
| | - Ward Cottaar
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hendrik Niemarkt
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Neonatology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Peter Andriessen
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Neonatology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Carola van Pul
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands
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7
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Ryan MAJ, Mathieson SR, Livingstone V, O'Sullivan MP, Dempsey EM, Boylan GB. Sleep state organisation of moderate to late preterm infants in the neonatal unit. Pediatr Res 2023; 93:595-603. [PMID: 36474114 PMCID: PMC9988685 DOI: 10.1038/s41390-022-02319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep supports neurodevelopment and sleep architecture reflects brain maturation. This prospective observational study describes the nocturnal sleep architecture of healthy moderate to late preterm (MLP) infants in the neonatal unit at 36 weeks post menstrual age (PMA). METHODS MLP infants, in the neonatal unit of a tertiary hospital in Ireland from 2017 to 2018, had overnight continuous electroencephalography (cEEG) with video for a minimum 12 h at 36 weeks PMA. The total sleep time (TST) including periods of active sleep (AS), quiet sleep (QS), indeterminate sleep (IS), wakefulness and feeding were identified, annotated and quantified. RESULTS A total of 98 infants had cEEG with video monitoring suitable for analysis. The median (IQR) of TST in the 12 h period was 7.09 h (IQR 6.61-7.76 h), 4.58 h (3.69-5.09 h) in AS, 2.02 h (1.76-2.36 h) in QS and 0.65 h (0.48-0.89 h) in IS. The total duration of AS was significantly lower in infants born at lower GA (p = 0.007) whilst the duration of individual QS periods was significantly higher (p = 0.001). CONCLUSION Overnight cEEG with video at 36 weeks PMA showed that sleep state architecture is dependent on birth GA. Infants with a lower birth GA have less AS and more QS that may have implications for later neurodevelopment. IMPACT EEG provides objective information about the sleep organisation of the moderate to late preterm (MLP) infant. Quantitative changes in sleep states occur with each week of advancing gestational age (GA). Active sleep (AS) is the dominant sleep state that was significantly lower in infants born at lower GA. MLP infants who were exclusively fed orally had a shorter total sleep time and less AS compared to infants who were fed via nasogastric tube.
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Affiliation(s)
- Mary Anne J Ryan
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Marc Paul O'Sullivan
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland. .,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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8
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Beunders VAA, Koopman-Verhoeff ME, Vermeulen MJ, Silva CCV, Jansen PW, Luik AI, Reiss IKM, Joosten KFM, Jaddoe VWV. Fetal and infant growth patterns, sleep, and 24-h activity rhythms: a population-based prospective cohort study in school-age children. J Sleep Res 2023:e13822. [PMID: 36707974 DOI: 10.1111/jsr.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 01/29/2023]
Abstract
The study objective was to explore associations of fetal and infant weight patterns and preterm birth with sleep and 24-h activity rhythm parameters at school-age. In our prospective population-based study, 1327 children were followed from birth to age 10-15 years. Fetal weight was estimated using ultrasound in the second and third trimester of pregnancy. Birth weight and gestational age were available from midwife registries. Infant weight was measured at 6, 12 and 24 months. Fetal and infant weight acceleration or deceleration were defined as a change of >0.67 standard deviation between the corresponding age intervals. At school-age, sleep duration, sleep efficiency, wake after sleep onset, social jetlag, inter-daily stability, and intra-daily variability were assessed using tri-axial wrist actigraphy for 9 consecutive nights. We observed that low birth weight (<2500 g) was associated with 0.24 standard deviation (95% confidence interval [CI] 0.04; 0.43) longer sleep duration compared to normal weight. Compared to normal growth, growth deceleration in fetal life and infancy was associated with 0.40 standard deviation (95% CI 0.07; 0.73) longer sleep duration, 0.44 standard deviation (95% CI 0.14; 0.73) higher sleep efficiency, and -0.41 standard deviation (95% CI -0.76; -0.07) shorter wake after sleep onset. A pattern of normal fetal growth followed by infant growth acceleration was associated with -0.40 standard deviation (95% CI -0.61; -0.19) lower inter-daily stability. Preterm birth was not associated with any sleep or 24-h rhythm parameters. Our findings showed that children with fetal and infant growth restriction had longer and more efficient sleep at school-age, which may be indicative of an increased need for sleep for maturational processes and development after a difficult start in life.
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Affiliation(s)
- Victoria A A Beunders
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Elisabeth Koopman-Verhoeff
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carolina C V Silva
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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9
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Lobermeier M, Hicks A, Staples AD, Huth-Bocks AC, Warschausky S, Taylor HG, Lukomski A, Brooks J, Lajiness-O’Neill R. Longitudinal changes in term and preterm infant night wakings: The role of caregiver anxious-depression. Infant Ment Health J 2023; 44:43-53. [PMID: 36515372 PMCID: PMC9840671 DOI: 10.1002/imhj.22024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
Changes in infant night waking during the first year of life are associated with individual (e.g., prematurity) and family (e.g., caregiver psychopathology) factors. This study examined the association between infant night waking and caregiver anxious-depressive symptoms during the first year of life in preterm and term infants. We considered between-person differences and within-person changes in caregiver anxious-depressive symptoms in relation to changes in infant night waking from 2- to 9-months. Racially (30.0% Black, 60.4% White, 9.5% multiracial/other) and socioeconomically (40.0% below median household income) diverse caregivers (N = 445) of full term (n = 258) and preterm (n = 187) infants were recruited from hospitals and clinics in two midwestern states. Caregivers completed measures of anxious-depression and their infant's night waking at four sampling periods (2-, 4-, 6-, and 9-months). Infant night wakings declined from 2- to 9-months. Between-person differences were observed, such that caregivers with higher average anxious-depressive symptoms or infants born full term reported more night wakings. Within-person effects of caregiver anxious-depressive symptoms were not significant. Caregiver anxious-depression is closely associated with infant night wakings. By considering a caregiver's average severity of anxious-depression, healthcare providers can more effectively plan infant sleep interventions. If caregiver anxious-depressive symptoms are ameliorated, night wakings may also decrease.
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Affiliation(s)
| | | | | | | | | | - H. Gerry Taylor
- Case Western Reserve University/University Hospitals
- Nationwide Children’s Hospital
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10
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Hall K, Patel R, Evans J, Greenwood R, Hicks J. The relationship between perinatal circadian rhythm and postnatal depression: an overview, hypothesis, and recommendations for practice. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractPostnatal depression (PND) is an important public health problem with far-reaching consequences for mothers, families, and society. Current treatment approaches tend to focus on the depressive symptoms of the mother. We propose the need for a shift in the conceptualisation of PND and its management, by focusing on circadian rhythm as an early manifestation of mother-infant synchrony. We have reviewed the relevant interdisciplinary literature to formulate a hypothesis and suggest recommendations for practice. We hypothesise that, after a mother’s circadian rhythm becomes ‘desynchronised’ immediately following birth, persistence of this disruption is implicated in the development of PND. This has important implications for novel treatment strategies in the critical and vulnerable postnatal period, for example the use of outdoor-based interventions and light.
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11
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Wong SD, Wright KP, Spencer RL, Vetter C, Hicks LM, Jenni OG, LeBourgeois MK. Development of the circadian system in early life: maternal and environmental factors. J Physiol Anthropol 2022; 41:22. [PMID: 35578354 PMCID: PMC9109407 DOI: 10.1186/s40101-022-00294-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/01/2022] [Indexed: 12/25/2022] Open
Abstract
In humans, an adaptable internal biological system generates circadian rhythms that maintain synchronicity of behavior and physiology with the changing demands of the 24-h environment. Development of the circadian system begins in utero and continues throughout the first few years of life. Maturation of the clock can be measured through sleep/wake patterns and hormone secretion. Circadian rhythms, by definition, can persist in the absence of environmental input; however, their ability to adjust to external time cues is vital for adaptation and entrainment to the environment. The significance of these external factors that influence the emergence of a stable circadian clock in the first years of life remain poorly understood. Infants raised in our post-modern world face adverse external circadian signals, such as artificial light and mistimed hormonal cues via breast milk, which may increase interference with the physiological mechanisms that promote circadian synchronization. This review describes the very early developmental stages of the clock and common circadian misalignment scenarios that make the developing circadian system more susceptible to conflicting time cues and temporal disorder between the maternal, fetal, infant, and peripheral clocks.
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12
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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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13
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Exploring Perceived Stress in Mothers with Singleton and Multiple Preterm Infants: A Cross-Sectional Study in Taiwan. Healthcare (Basel) 2022; 10:healthcare10081593. [PMID: 36011252 PMCID: PMC9408488 DOI: 10.3390/healthcare10081593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of this study was to explore mothers’ perceived level of stress one month after hospital discharge following the birth of singleton and multiple preterm infants. Design: A cross-sectional design was used to compare mother’s perceived stress in two groups of postpartum mothers and the relationship of the theoretical antecedents and these variables. Setting: A neonatal intensive care unit in a medical center in Taiwan. Participants: Mothers of 52 singletons and 38 multiple premature infants were recruited. One month after the infant was discharged, the participants completed a self-reported questionnaire that included demographic data about the mother and infant, the 21-item Social Support Scale, and the 15-item Perceived Stress Scale. This was returned by email or completed at the outpatient unit. Analysis: Descriptive and inferential analysis. Results: The mean social support scores were 76.6 and 76.5 (out of 105) for mothers with singleton and multiple birth infants, respectively. The most important supporter was the husband. The mean perceived stress scores of 25.8 and 31.0 for mothers with singleton and multiple birth infants, respectively, were significantly different (p = 0.02). Sleep deprivation and social support were predictive indicators of perceived stress in mothers with preterm infants. Conclusions: We suggest that the differences in stress and needs of mothers with singleton and multiple births should be recognized and addressed in clinics. The findings of this study serve as a reference for promoting better preterm infant care.
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14
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Do preterm babies sleep differently than their peers? Sleep characteristics and their associations with maternal depression and parenting stress. Sleep Med 2022; 90:109-116. [DOI: 10.1016/j.sleep.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/21/2022]
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15
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Huang Q, Lai X, Liao J, Tan Y. Effect of non-pharmacological interventions on sleep in preterm infants in the neonatal intensive care unit: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27587. [PMID: 34713833 PMCID: PMC8556050 DOI: 10.1097/md.0000000000027587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Premature infants are prone to suffer multisystem complications after birth due to the incomplete development of organ tissues and low immunity, and they require a longer period of supervised treatment in the neonatal intensive care unit (NICU). However, due to the specificity of medical care in the NICU, the sleep of preterm infants is highly susceptible that has an impact on the prognosis of preterm infants. Recently, various non-pharmacological interventions have been applied to the sleep of preterm infants in the NICU, which have shown positive outcomes. However, the efficacy and safety of them are unclear. This study aims to evaluate the effects of non-pharmacological interventions on sleep in preterm infants in the NICU through a network meta-analysis. METHODS Randomized controlled trials of non-pharmacological interventions on sleep in preterm infants in the NICU published before September 2021 will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science. Two researchers will be independently responsible for screening and selecting eligible literatures, extracting data and evaluating the risk of bias in the included studies. Stata 14.0 software will be used for data analysis. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide comprehensive and reliable evidence-based references for the efficacy and safety in different non-pharmacological interventions on sleep in preterm infants in the NICU.
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Affiliation(s)
- Qingchun Huang
- Department of Neonatology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Xin Lai
- Department of Pediatric Critical Illness, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Jianhua Liao
- Department of Child Health Care, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Yingchao Tan
- Department of Neonatology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
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16
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An Introduction to Neonatal EEG. J Perinat Neonatal Nurs 2021; 35:369-376. [PMID: 34726654 DOI: 10.1097/jpn.0000000000000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Newborn care has witnessed significant improvements in survival, but ongoing concerns persist about neurodevelopmental outcome. Protecting the newborn brain is the focus of neurocritical care in the intensive care unit. Brain-focused care places emphasis on clinical practices supporting neurodevelopment in conjunction with early detection, diagnosis, and treatment of brain injury. Technology now facilitates continuous cot-side monitoring of brain function. Neuromonitoring techniques in neonatal intensive care units include the use of electroencephalography (EEG) or amplitude-integrated EEG (aEEG) and near-infrared spectroscopy. This article aims to provide an introduction to EEG, which is appropriate for neonatal healthcare professionals.
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17
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Hazelhoff EM, Dudink J, Meijer JH, Kervezee L. Beginning to See the Light: Lessons Learned From the Development of the Circadian System for Optimizing Light Conditions in the Neonatal Intensive Care Unit. Front Neurosci 2021; 15:634034. [PMID: 33815040 PMCID: PMC8013699 DOI: 10.3389/fnins.2021.634034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
The circadian timing system optimizes health by temporally coordinating behavior and physiology. During mammalian gestation, fetal circadian rhythms are synchronized by the daily fluctuations in maternal body temperature, hormones and nutrients. Circadian disruption during pregnancy is associated with negative effects on developmental outcomes in the offspring, highlighting the importance of regular and robust 24-h rhythms over gestation. In the case of preterm birth (before 37 weeks of gestation), maternal cues no longer synchronize the neonate's circadian system, which may adversely affect the neonate. There is increasing evidence that introducing robust light-dark cycles in the Neonatal Intensive Care Unit has beneficial effects on clinical outcomes in preterm infants, such as weight gain and hospitalization time, compared to infants exposed to constant light or constant near-darkness. However, the biological basis for these effects and the relationship with the functional and anatomical development of the circadian system is not fully understood. In this review, we provide a concise overview of the effects of light-dark cycles on clinical outcomes of preterm neonates in the NICU and its alignment with the development of the circadian system.
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Affiliation(s)
- Esther M. Hazelhoff
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital and Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johanna H. Meijer
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Laura Kervezee
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
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18
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Schoch SF, Kurth S, Werner H. Actigraphy in sleep research with infants and young children: Current practices and future benefits of standardized reporting. J Sleep Res 2020; 30:e13134. [PMID: 32638500 PMCID: PMC8244022 DOI: 10.1111/jsr.13134] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Actigraphy is a cost‐efficient method to estimate sleep–wake patterns over long periods in natural settings. However, the lack of methodological standards in actigraphy research complicates the generalization of outcomes. A rapidly growing methodological diversity is visible in the field, which increasingly necessitates the detailed reporting of methodology. We address this problem and evaluate the current state of the art and recent methodological developments in actigraphy reporting with a special focus on infants and young children. Through a systematic literature search on PubMed (keywords: sleep, actigraphy, child *, preschool, children, infant), we identified 126 recent articles (published since 2012), which were classified and evaluated for reporting of actigraphy. Results show that all studies report on the number of days/nights the actigraph was worn. Reporting was good with respect to device model, placement and sleep diary, whereas reporting was worse for epoch length, algorithm, artefact identification, data loss and definition of variables. In the studies with infants only (n = 58), the majority of articles (62.1%) reported a recording of actigraphy that was continuous across 24 hr. Of these, 23 articles (63.9%) analysed the continuous 24‐hr data and merely a fifth used actigraphy to quantify daytime sleep. In comparison with an evaluation in 2012, we observed small improvements in reporting of actigraphy methodology. We propose stricter adherence to standards in reporting methodology in order to streamline actigraphy research with infants and young children, to improve comparability and to facilitate big data ventures in the sleep community.
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Affiliation(s)
- Sarah F Schoch
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Salome Kurth
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Helene Werner
- Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.,Division of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Zürich, Switzerland
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19
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Abstract
Sleep is a necessary function of life. Fetuses and neonates spend most of their day sleeping, making it paramount to place emphasis on adequate and optimal sleep. As the current body of literature continues to expand, we have increased our understanding of sleep and its role in development. Sleep disturbances, particularly early in life can affect all aspects of health such as neurological development, emotional well-being, and overall growth. This article aims to provide a primer on sleep development from fetal life into the neonatal period, discuss sleep in both the home and hospital settings, explore the tools used to measure sleep, and review common interventions applied to those infants experiencing poor sleep. Lastly, there is a mention of long-term outcomes and how early recognition and implementation of measures could help to improve overall growth and development throughout childhood. [Pediatr Ann. 2020;49(2):e82-e87.].
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20
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Romeo DM, Leo G, Lapenta L, Leone D, Turrini I, Brogna C, Gallini F, Cota F, Vento G, Mercuri E. Sleep disorders in low-risk preschool very preterm children. Sleep Med 2019; 63:137-141. [DOI: 10.1016/j.sleep.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/09/2023]
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21
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Infant crying and the calming response: Parental versus mechanical soothing using swaddling, sound, and movement. PLoS One 2019; 14:e0214548. [PMID: 31017930 PMCID: PMC6481793 DOI: 10.1371/journal.pone.0214548] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background Frequent infant crying is associated with parental exhaustion, depression, or even infant hospitalization and shaken baby syndrome. Effective prompt soothing methods are lacking for infants under 6 months. We examined whether swaddling, sound, and movement evoked an immediate calming response (CR) when parents soothed their infants and using a smart crib, and whether infant age affected the CR. Methods Infants’ CR was assessed in a community sample of 69 infants (0–6 months) in a counterbalanced experiment with two conditions (parent, smart crib) each composed of three two-minute phases (baseline, supine, soothing). During baseline 1, parent and infant were sitting together; in supine 1, fussiness was elicited by putting the infant suddenly supine, followed by parental soothing (shushing and jiggling of the swaddled infant). Baseline 2, supine 2, and soothing by the crib followed. Fussiness was observed and infant heart rate (HR) and heart rate variability (HRV) were recorded. The CR was operationalized as decreased fussiness and HR, and increased HRV during soothing compared to lying supine. Results Infant fussiness and HR were lower in both soothing phases compared to the supine phases. Infant HRV tended to be higher during parental soothing than during supine, but did not significantly differ between mechanical soothing and supine. Younger infants responded with a stronger CR (decreased fussiness and increased HRV) to parental soothing, but not to mechanical soothing. For HR, infants’ CR was stronger in the crib than in the parent condition, whereas for HRV, infants’ CR was stronger in the parent condition. For fussiness, infants’ CR tended to be stronger in the parent condition. Conclusion Parental and mechanical soothing using swaddling, sound, and movement promptly induced a CR in infants. This has important clinical implications for soothing fussy and crying infants. Future studies should investigate the effects of parental versus mechanical soothing in the home setting.
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22
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Gottlob S, Gille C, Poets CF. Randomized Controlled Trial on the Effects of Morning versus Evening Primary Vaccination on Episodes of Hypoxemia and Bradycardia in Very Preterm Infants. Neonatology 2019; 116:315-320. [PMID: 31394525 DOI: 10.1159/000501338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypoxemia and bradycardia occur frequently in preterm infants, but are incompletely understood. They are more prevalent during infections and following immunization. Data on adults suggested an increased immune response if subjects slept following vaccination, suggesting an interaction between circadian rhythm and the immune system. Whether this holds true for preterm infants with their less well-established circadian rhythm is unclear. OBJECTIVE Do infants born at 26-30 weeks' gestation and having received their first routine hexavalent vaccination in the morning have a lower cardiorespiratory event rate (CER) after vaccination than those receiving it in the evening? METHODS Twenty-six infants were randomized to an evening versus morning vaccination group in a pilot and main study with 10 and 16 participants, respectively. Pulse oximeter saturation, actigraphy, and rectal temperature were obtained for 24 h before and after vaccination. Blood samples for vaccination titers were taken before vaccination and during a follow-up examination in our outpatient clinic; another blood sample was taken 24 h after vaccination to determine inflammatory markers. RESULTS Vaccination led to an increase in CER in both groups, but there was no difference in CER between the morning and evening groups. Vaccination titers for Bordetella pertussis were increased in both groups, with no difference in inflammatory markers 24 h after vaccination. Body temperature increased in both groups after vaccination. Participants in the evening group slept longer after vaccination. CONCLUSIONS We did not identify a difference in CER between morning and evening vaccination but could confirm increased body temperatures and vaccination titers following vaccination.
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Affiliation(s)
- Stefan Gottlob
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Christian Gille
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Tübingen, Germany,
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23
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Abstract
Many processes in the human body - including brain function - are regulated over the 24-hour cycle, and there are strong associations between disrupted circadian rhythms (for example, sleep-wake cycles) and disorders of the CNS. Brain disorders such as autism, depression and Parkinson disease typically develop at certain stages of life, and circadian rhythms are important during each stage of life for the regulation of processes that may influence the development of these disorders. Here, we describe circadian disruptions observed in various brain disorders throughout the human lifespan and highlight emerging evidence suggesting these disruptions affect the brain. Currently, much of the evidence linking brain disorders and circadian dysfunction is correlational, and so whether and what kind of causal relationships might exist are unclear. We therefore identify remaining questions that may direct future research towards a better understanding of the links between circadian disruption and CNS disorders.
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Affiliation(s)
- Ryan W Logan
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Colleen A McClung
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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24
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Aswathy B, Kumar VM, Gulia KK. Immature sleep pattern in newborn rats when dams encountered sleep restriction during pregnancy. Int J Dev Neurosci 2018; 69:60-67. [DOI: 10.1016/j.ijdevneu.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/09/2018] [Accepted: 06/24/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- B.S. Aswathy
- Division of Sleep ResearchBiomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrum695012KeralaIndia
| | - Velayudhan M. Kumar
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrum695012KeralaIndia
| | - Kamalesh K. Gulia
- Division of Sleep ResearchBiomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and TechnologyTrivandrum695012KeralaIndia
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25
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Bennet L, Walker DW, Horne RSC. Waking up too early - the consequences of preterm birth on sleep development. J Physiol 2018; 596:5687-5708. [PMID: 29691876 DOI: 10.1113/jp274950] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022] Open
Abstract
Good quality sleep of sufficient duration is vital for optimal physiological function and our health. Sleep deprivation is associated with impaired neurocognitive function and emotional control, and increases the risk for cardiometabolic diseases, obesity and cancer. Sleep develops during fetal life with the emergence of a recognisable pattern of sleep states in the preterm fetus associated with the development, maturation and connectivity within neural networks in the brain. Despite the physiological importance of sleep, surprisingly little is known about how sleep develops in individuals born preterm. Globally, an estimated 15 million babies are born preterm (<37 weeks gestation) each year, and these babies are at significant risk of neural injury and impaired brain development. This review discusses how sleep develops during fetal and neonatal life, how preterm birth impacts on sleep development to adulthood, and the factors which may contribute to impaired brain and sleep development, leading to altered neurocognitive, behavioural and motor capabilities in the infant and child. Going forward, the challenge is to identify specific risk factors for impaired sleep development in preterm babies to allow for the design of interventions that will improve the quality and quantity of sleep throughout life.
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Affiliation(s)
- Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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26
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Lan HY, Yang L, Hsieh KH, Yin T, Chang YC, Liaw JJ. Effects of a supportive care bundle on sleep variables of preterm infants during hospitalization. Res Nurs Health 2018; 41:281-291. [PMID: 29675875 DOI: 10.1002/nur.21865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 01/18/2023]
Abstract
Sleep is important for preterm infants' brain development, but they are frequently exposed to painful procedures in the neonatal intensive care unit (NICU) that disturb their sleep cycle and affect their growth. The purpose of this study was to examine the prolonged effects of a supportive care bundle (modulation of the infants' states, non-nutritive sucking, facilitated tucking, and oral sucrose feeding) on preterm infants' sleep variables (sleep efficiency, total sleep time, sleep latency, and frequency of wake bouts) during hospitalization. The team recruited 65 preterm infants (gestational age at birth 28-36 weeks, average birth weight 1,652 g) from a Level III NICU at a medical center in Taiwan. Infants were randomly assigned to one of two treatment conditions to be administered while receiving intrusive procedures: (1) control condition (usual care, including routine procedures, positioning, and gentle touch); or (2) intervention condition in which the supportive care bundle was added to usual care. Sleep variables were measured using actigraphy for a baseline of three continuous days on the 6th to 8th days after birth and again for 3 continuous days when infants weighed ≧1,950 g. Two forms of generalized estimating equation analyses with control of significant covariates were used for data analysis. The supportive care bundle not only significantly increased sleep efficiency and total sleep time but also significantly decreased duration of sleep latency and frequency of wake bouts. These results provide evidence to support the incorporation of the supportive care bundle into NICU clinical practice during intrusive procedures.
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Affiliation(s)
- Hsiang-Yun Lan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Luke Yang
- Department of Social Work, Hsuan Chuang University, Taipei, Taiwan
| | - Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan
| | - Ti Yin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Song-Shan Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
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27
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Barbeau DY, Weiss MD. Sleep Disturbances in Newborns. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E90. [PMID: 29053622 PMCID: PMC5664020 DOI: 10.3390/children4100090] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environment, and the amplitude integrated EEG can be a useful tool in evaluating sleep, and sleep disturbances, in neonates. Finally, there are protective factors for infant sleep that are still being studied.
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Affiliation(s)
| | - Michael D Weiss
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA.
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28
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Dereymaeker A, Pillay K, Vervisch J, De Vos M, Van Huffel S, Jansen K, Naulaers G. Review of sleep-EEG in preterm and term neonates. Early Hum Dev 2017; 113:87-103. [PMID: 28711233 PMCID: PMC6342258 DOI: 10.1016/j.earlhumdev.2017.07.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neonatal sleep is a crucial state that involves endogenous driven brain activity, important for neuronal survival and guidance of brain networks. Sequential EEG-sleep analysis in preterm infants provides insights into functional brain integrity and can document deviations of the biologically pre-programmed process of sleep ontogenesis during the neonatal period. Visual assessment of neonatal sleep-EEG, with integration of both cerebral and non-cerebral measures to better define neonatal state, is still considered the gold standard. Electrographic patterns evolve over time and are gradually time locked with behavioural characteristics which allow classification of quiet sleep and active sleep periods during the last 10weeks of gestation. Near term age, the neonate expresses a short ultradian sleep cycle, with two distinct active and quiet sleep, as well as brief periods of transitional or indeterminate sleep. Qualitative assessment of neonatal sleep is however challenged by biological and environmental variables that influence the expression of EEG-sleep patterns and sleep organization. Developing normative EEG-sleep data with the aid of automated analytic methods, can further improve our understanding of extra-uterine brain development and state organization under stressful or pathological conditions. Based on those developmental biomarkers of normal and abnormal brain function, research can be conducted to support and optimise sleep in the NICU, with the ultimate goal to improve therapeutic interventions and neurodevelopmental outcome.
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Affiliation(s)
- Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Kirubin Pillay
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Jan Vervisch
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Maarten De Vos
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Sabine Van Huffel
- KU Leuven (University of Leuven), Department of Electrical Engineering-ESAT, Division Stadius, Leuven, Belgium; Imec, Leuven, Belgium.
| | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
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29
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Caravale B, Sette S, Cannoni E, Marano A, Riolo E, Devescovi A, De Curtis M, Bruni O. Sleep Characteristics and Temperament in Preterm Children at Two Years of Age. J Clin Sleep Med 2017; 13:1081-1088. [PMID: 28760193 DOI: 10.5664/jcsm.6728] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/06/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to compare 2-year-old children born preterm with children born full term regarding: (1) sleep characteristics, (2) temperament, and (3) relations between sleep pattern and habits and temperament. METHODS The study included 51 preterm children with normal cognitive, language, and motor development (mean = 20.94 months, standard deviation [SD] = 4.08) and 57 full-term children (mean = 21.19, SD = 4.32). To assess sleep-related difficulties and habits and child temperament, mothers completed the following questionnaires: the (1) Sleep Disturbance Scale for Children-adapted (SDSC); (2) Brief Infant Sleep Questionnaire (BISQ); and (3) Italian Temperament Questionnaires-version 12-36 months (QUIT). RESULTS Preterm children needed less support to fall asleep and fell asleep more often alone in their own bed compared to those born at full term; however, preterm children showed more frequent sleep difficulties, such as restlessness and breathing problems during the night. In addition, preterm children had lower scores in the temperamental dimension of attention and higher scores in negative emotionality than full-term children. Finally, sleep problems were correlated with higher motor activity, lower social orientation and attention, and increased negative emotionality; a shorter nocturnal sleep duration was related to higher motor activity and lower inhibition to novelty whereas an earlier rise time was associated with lower attention and social orientation. CONCLUSIONS Preterm children showed sleep pattern problems and disturbance, predominance of attention problems, and negative emotionality related to sleep disruption.
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Affiliation(s)
- Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefania Sette
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Eleonora Cannoni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Assunta Marano
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Erika Riolo
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonella Devescovi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Mario De Curtis
- Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
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30
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Lan HY, Yin T, Chen JL, Chang YC, Liaw JJ. Factors Associated With Preterm Infants’ Circadian Sleep/Wake Patterns at the Hospital. Clin Nurs Res 2017; 28:456-472. [DOI: 10.1177/1054773817724960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants’ circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants’ total sleep time ( B = 41.828, p < .01) and percentage of sleep time ( B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants’ sleep problems, signaling the need to provide individualized support to maintain these infants’ sleep quality during their early life.
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Affiliation(s)
- Hsiang-Yun Lan
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | - Ti Yin
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
- Nursing Department, Song-Shan Branch,Tri-Service General Hospital, Taipei City, Taiwan (R.O.C.)
| | | | | | - Jen-Jiuan Liaw
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
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31
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Brandon DH, Silva SG, Park J, Malcolm W, Kamhawy H, Holditch-Davis D. Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized Controlled Trial. Res Nurs Health 2017; 40:294-310. [PMID: 28431191 DOI: 10.1002/nur.21797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/23/2022]
Abstract
Day-night cycled light improves health outcomes in preterm infants, yet the best time to institute cycled light is unclear. The hypothesis of this study was that extremely preterm infants receiving early cycled light would have better health and developmental outcomes than infants receiving late cycled light. Infants born at ≤28 weeks gestation were randomly assigned to early cycled light (ECL) starting at 28 weeks postmenstrual age [PMA] or late cycled light (LCL), starting at 36 weeks PMA. Daylight was 200-600 lux and night was 5-30 lux. Primary outcomes were weight over time and length of hospitalization. Secondary outcomes were hospital costs, sleep development, and neurodevelopment at 9, 18, and 24 months corrected age. Of 121 infants randomized, 118 were included in analysis. Weight gain in the two groups did not differ significantly but increased across time in both groups. In PMA weeks 36-44, the mean weight gain was 193.8 grams in the ECL group compared to 176.3 grams in the LCL group. Effect sizes for weight were Cohen d = 0.26 and 0.36 for 36 and 44 weeks PMA. Infants in the ECL group went home an average of 5.5 days earlier than the LCL group, but this difference was not statistically significant. There were no group differences on neurodevelopmental outcomes. Although statistically non-significant, clinically important differences of improved weight gain and decreased hospital stay were observed with ECL. The small observed effect sizes on weight during hospitalization should be considered in future cycled light research with extremely preterm infants. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Debra H Brandon
- Associate Professor and Director of PhD and Post-Doctoral Programs, School of Nursing, Department of Pediatrics, School of Medicine, Duke University, DUMC 3322, 307 Trent Dr., Durham, NC, 27710
| | - Susan G Silva
- Associate Professor, Duke University School of Nursing, Durham, NC
| | - Jinhee Park
- Assistant Professor, Boston College William F. Connell School of Nursing, Chestnut Hill, MA
| | - William Malcolm
- Associate Professor, Department of Pediatrics, School of Medicine, Duke University, Durham, NC
| | - Heba Kamhawy
- Research Assistant, Duke University School of Nursing, Durham, NC
| | - Diane Holditch-Davis
- Marcus Hobbs Distinguished Professor Emerita of Nursing, Duke University School of Nursing, Durham, NC
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Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol 2017; 37:323-332. [PMID: 27763631 PMCID: PMC5389912 DOI: 10.1038/jp.2016.179] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes. STUDY DESIGN The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists. RESULTS Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature. CONCLUSIONS Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.
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Affiliation(s)
- R Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - R Guth
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO, USA
| | - A Herring
- Center for Clinical Excellence, BJC HealthCare, St Louis, MO, USA
| | - L Reynolds
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - S Oberle
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - J Smith
- St Louis Children's Hospital, St Louis, MO, USA
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Blomqvist YT, Nyqvist KH, Rubertsson C, Funkquist E. Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem. Acta Paediatr 2017; 106:223-228. [PMID: 27925691 DOI: 10.1111/apa.13660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/09/2016] [Accepted: 11/02/2016] [Indexed: 11/27/2022]
Abstract
AIM This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home. METHODS The study was conducted in the NICUs of two Swedish university hospitals. The parents of 86 infants - 86 mothers and 84 fathers - answered questionnaires during their infants' hospital stay, at discharge and at the infants' corrected ages of two, six and 12 months. The parents' own sleep was explored with the Insomnia Severity Index. RESULTS Mothers reported more severe insomnia than fathers during their infants' hospitalisation, and these higher insomnia severity scores were associated with more severe infant sleep problems at discharge (p = 0.027) and at two months (p = 0.006) and 12 months (p = 0.002) of corrected age. During the study period, 4%-10% of the parents reported severe or very severe infant sleeping problems. The bed-sharing rate was 75% after discharge and about 60% at the corrected age of 12 months. CONCLUSION Maternal insomnia during an infant's hospital stay was associated with later perceptions of sleep problems in their children. Parents need support to find solutions for optimal sleep without seeing their child's sleeping patterns as a problem.
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Affiliation(s)
- Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit 95 F Uppsala University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health University Hospital Uppsala Sweden
| | | | | | - Eva‐Lotta Funkquist
- Department of Women's and Children's Health University Hospital Uppsala Sweden
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34
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Bueno C, Menna-Barreto L. Environmental factors influencing biological rhythms in newborns: From neonatal intensive care units to home. ACTA ACUST UNITED AC 2017; 9:295-300. [PMID: 28154744 PMCID: PMC5279954 DOI: 10.1016/j.slsci.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022]
Abstract
Photic and non-photic environmental factors are suggested to modulate the development of circadian rhythms in infants. Our aim is to evaluate the development of biological rhythms (circadian or ultradian) in newborns in transition from Neonatal Intensive Care Units (NICU) to home and along the first 6 months of life, to identify masking and entraining environment factors along development. Ten newborns were evaluated in their last week inside the NICU and in the first week after being delivered home; 6 babies were also followed until 6 months of corrected age. Activity, recorded with actimeters, wrist temperature and observed sleep and feeding behavior were recorded continuously along their last week inside the NICU and in the first week at home and also until 6 months of corrected age for the subjects who remained in the study. Sleep/wake and activity/rest cycle showed ultradian patterns and the sleep/wake was strongly influenced by the 3 h feeding schedule inside the NICU, while wrist temperature showed a circadian pattern that seemed no to be affected by environmental cycles. A circadian rhythm emerges for sleep/wake behavior in the first week at home, whereas the 3 h period vanishes. Both activity/rest and wrist temperature presented a sudden increase in the contribution of the circadian component immediately after babies were delivered home, also suggesting a masking effect of the NICU environment. We found a positive correlation of postconceptional age and the increase in the daily component of activity and temperature along the following 6 months, while feeding behavior became arrhythmic.
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Affiliation(s)
- Clarissa Bueno
- Departmento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, Cidade Universitária, Av. Lineu Prestes, 1524, Butantã, Cep:05508-900 São Paulo, SP, Brazil
- Corresponding author. Present address: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr Enéas de Carvalho Aguiar, 255. Cerqueira César, Cep:05403-000 São Paulo, SP, Brazil.
| | - Luiz Menna-Barreto
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Av. Arlindo Béttio, 1000. Ermelino Matarazzo, Cep:03828-000 São Paulo, SP, Brazil
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35
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Orsi KCSC, Avena MJ, Lurdes de Cacia Pradella-Hallinan M, da Luz Gonçalves Pedreira M, Tsunemi MH, Machado Avelar AF, Pinheiro EM. Effects of Handling and Environment on Preterm Newborns Sleeping in Incubators. J Obstet Gynecol Neonatal Nurs 2017; 46:238-247. [PMID: 28056335 DOI: 10.1016/j.jogn.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe the total sleep time, stages of sleep, and wakefulness of preterm newborns and correlate them to levels of sound pressure, light, temperature, relative air humidity, and handling inside incubators. DESIGN Observational, correlational study. SETTING A neonatal intermediate care unit. PARTICIPANTS Twelve preterm newborns, who were 32.2 ± 4.2 weeks gestational age and weighed 1,606 ± 317 g. METHODS Sleep records were assessed by polysomnograph. Environmental variables were measured with a noise dosimeter, light meter, and thermohygrometer. To record time and frequency of handling, a video camera was used. All recordings were made for an uninterrupted 24-hour period. RESULTS Mean total sleep time in 24 hours was 899 ± 71.8 minutes (daytime = 446 ± 45.3 and nighttime = 448 ± 60.2). Mean wakefulness was 552 ± 94.0 minutes. The predominant stage was quiet sleep. A significant correlation was identified only between the levels of light and wakefulness (r = 0.65 and p = .041). CONCLUSION The environmental conditions and care provided to hospitalized preterm newborns did not influence sleep except for high light levels, which increased wakefulness. Nurses in clinical practice should implement strategies to promote and protect sleep by decreasing newborns' exposure to excessive light.
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36
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Abstract
There have been amazing changes in outcomes of preterm (PT) infants in the past decades. Whereas early studies reported only survival rates, Dr. Julius Hess published the first outcome study of PT infants in Chicago in 1953. Dr. Lubchenco then published the 10-year follow-up of premature infants born in 1947-1953 and identified a 68% handicap rate. As a result of these early studies, the importance of evaluating NICU graduates both for surveillance and as an outcome of trials was recognized. During the 1970s, there was a gradual expansion in the number of follow-up programs in the United States (US) with an increasing number of follow-up studies published. In the 1980s, the importance of multicenter clinical research networks was recognized and the NICHD Neonatal Research Network (NRN) was initiated in 1986. Follow-up protocols, definitions, and outcomes have evolved over the last 30 years and will be reviewed with a focus on NICHD NRN studies.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304
| | - Jamie E Newman
- Public Health Research Division, RTI International, Research Triangle Park, NC
| | - Betty R Vohr
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Women & Infants Hospital of Rhode Island, Providence, RI.
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37
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Bueno C, Menna-Barreto L. Development of sleep/wake, activity and temperature rhythms in newborns maintained in a neonatal intensive care unit and the impact of feeding schedules. Infant Behav Dev 2016; 44:21-8. [PMID: 27261553 DOI: 10.1016/j.infbeh.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Biological rhythms in infants are described as evolving from an ultradian to a circadian pattern along the first months of life. Recently, the use of actigraphy and thermistors with memory has contributed to the understanding of temporal relations of different variables along development. The aim of this study was to describe and compare the development of the rhythmic pattern of wrist temperature, activity/rest cycle, sleep/wake and feeding behavior in term and preterm newborns maintained in a neonatal intensive care unit (NICU). METHODS Nineteen healthy preterm and seven fullterm newborns had the following variables monitored continuously while they were in the NICU: activity recorded by actigraphy, wrist temperature recorded with a thermistor and observed sleep and feeding behavior recorded by the NICU staff with diaries. Subjects were divided in 3 groups according to their gestational age at birth and rhythmic parameters were compared. RESULTS A dominant daily rhythm was observed for wrist temperature since the first two weeks of life and no age relation was demonstrated. Otherwise, a daily pattern in activity/rest cycle was observed for most preterm newborns since 35 weeks of postconceptional age and was more robust in term babies. Feeding and sleep/wake data showed an almost exclusive 3h rhythm, probably related to a masking effect of feeding schedules. CONCLUSIONS We found that wrist temperature develops a daily pattern as soon as previously reported for rectal temperature, and with acrophase profile similar to adults. Moreover, we were able to find a daily rhythm in activity/rest cycle earlier than previously reported in literature. We also suggest that sleep/wake rhythm and feeding behavior follow independent developmental courses, being more suitable to masking effects.
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Affiliation(s)
- Clarissa Bueno
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of São Paulo, Brazil.
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Circadian Sleep Patterns in Toddlers Born Preterm: Longitudinal Associations with Developmental and Health Concerns. J Dev Behav Pediatr 2016; 37:358-69. [PMID: 27011003 PMCID: PMC4887334 DOI: 10.1097/dbp.0000000000000287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Children born preterm are at elevated risk for several developmental and health concerns. Early sleep patterns may be associated with these concerns. The current study assesses the associations between toddler circadian sleep/activity patterns and later developmental, behavioral, attentional, and health concerns in this at-risk population. METHOD We examined circadian sleep/activity patterns at 2 years of age in 99 children born preterm. Child cognitive skills were tested at 3 years of age, and behavior, attention, and health concerns were reported at 3 and 6 years of age. First, sleep/activity data collected via actigraphy were assessed using time series analysis (TSA). For this, we assessed how each child's sleep/activity pattern compared to a specified 24-hour circadian cycle (SCC) with an adjustment for daytime napping. Second, in a series of regression models child sleep/activity parameters from the TSA were assessed with child gender, prematurity, and family sociodemographic assets as covariates. RESULTS Toddlers with patterns that closely aligned with the SCC had higher abbreviated intelligence quotient scores at 3 years of age. Additionally, at 6 years these children had a lower risk for illness-related medical visits. Higher toddler average activity level was associated with fewer teacher-reported attention-deficit hyperactivity disorder symptoms and a lower risk for illness-related medical visits. CONCLUSION The novel approach used in this study to index child circadian patterns provides a pattern-based analysis of sleep/activity, which may prove to be developmentally consequential. With replication, these findings may help practitioners promote optimal cognitive and health development via circadian sleep supports in infants born preterm.
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Cremer M, Jost K, Gensmer A, Pramana I, Delgado-Eckert E, Frey U, Schulzke SM, Datta AN. Immediate effects of phototherapy on sleep in very preterm neonates: an observational study. J Sleep Res 2016; 25:517-523. [PMID: 27140951 DOI: 10.1111/jsr.12408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 02/27/2016] [Indexed: 11/29/2022]
Abstract
Process C (internal clock) and Process S (sleep-wake homeostasis) are the basis of sleep-wake regulation. In the last trimester of pregnancy, foetal heart rate is synchronized with the maternal circadian rhythm. At birth, this interaction fails and an ultradian rhythm appears. Light exposure is a strong factor influencing the synchronization of sleep-wake processes. However, little is known about the effects of phototherapy on the sleep rhythm of premature babies. It was hypothesized that sleep in preterm infants would not differ during phototherapy, but that a maturation effect would be seen. Sleep states were studied in 38 infants born < 32 weeks gestational age and/or < 1 500 g birth weight. Videos of 3 h were taken over the first 5 days of life. Based on breathing and movement patterns, behavioural states were defined as: awake; active sleep; or quiet sleep. Videos with and without phototherapy were compared for amounts of quiet sleep and active states (awake + active sleep). No significant association between phototherapy and amount of quiet sleep was found (P = 0.083). Analysis of videos in infants not under phototherapy revealed an increase in time spent awake with increasing gestational age. The current data suggest that the ultradian rhythm of preterm infants seems to be independent of phototherapy, supporting the notion that sleep rhythm in this population is mainly driven by their internal clock.
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Affiliation(s)
- Martin Cremer
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kerstin Jost
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Neonatology, University of Basel Childrens' Hospital, Basel, Switzerland
| | - Anna Gensmer
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Isabelle Pramana
- Division of Neonatology, University of Basel Childrens' Hospital, Basel, Switzerland
| | - Edgar Delgado-Eckert
- Computational Physiology and Biostatistics, University of Basel Childrens' Hospital, Basel, Switzerland
| | - Urs Frey
- Department of Pediatrics, University of Basel Childrens' Hospital, Basel, Switzerland
| | - Sven M Schulzke
- Division of Neonatology, University of Basel Childrens' Hospital, Basel, Switzerland.,Department of Pediatrics, University of Basel Childrens' Hospital, Basel, Switzerland
| | - Alexandre N Datta
- Department of Pediatrics, University of Basel Childrens' Hospital, Basel, Switzerland. .,Division of Pediatric Neurology and Developmental Medicine, University of Basel Childrens' Hospital, Basel, Switzerland.
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