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Yoshida M, Ikeda A, Adachi H. Contributions of the light environment and co-sleeping to sleep consolidation into nighttime in early infants: A pilot study. Early Hum Dev 2024; 189:105923. [PMID: 38218083 DOI: 10.1016/j.earlhumdev.2023.105923] [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: 08/28/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Sleep consolidation into nighttime is considered the primary goal of sleep development in early infants. However, factors contributing to sleep consolidation into nighttime remain unclear. AIM To clarify the influences of the light environment and nighttime co-sleeping on sleep consolidation into nighttime in early infants. STUDY DESIGN Cross-sectional study. SUBJECTS AND METHODS Sleep-wake time and light stimulation were measured in infants for 4 consecutive days using actigraphy. The infants' mothers were asked to complete a sleep events diary and a questionnaire about childcare, including "co-sleeping", defined as when the infant and mother slept on the same surface throughout the night. OUTCOME MEASURES The data were analyzed with a focus on daytime and nighttime sleep parameters. RESULTS Daytime light stimulation reduced daytime "active sleep", tended to reduce daytime sleep, and increased daytime waking. Nighttime light stimulation reduced nighttime "quiet sleep" and nighttime sleep and increased nighttime waking. Co-sleeping reduced nighttime waking, and, as a result, nighttime sleep time and sleep efficiency increased. Co-sleeping reduced daytime sleep and tended to increase daytime waking. Consequently, co-sleeping tended to increase the ratio of nighttime sleep to daytime sleep. CONCLUSIONS The present findings suggest that an appropriate light environment promotes daytime waking and nighttime sleep in early infants, but it does not contribute to sleep consolidation into nighttime by itself. On the other hand, co-sleeping may promote sleep consolidation into nighttime. Therefore, further methods for safe co-sleeping need to be established while avoiding risk factors for sudden unexpected death in infancy/sudden infant death syndrome.
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Affiliation(s)
- Michiko Yoshida
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0812, Japan; Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, School of Health Science, 1-1-1 Hondo, Akita 010-8543, Japan.
| | - Atsuko Ikeda
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0812, Japan.
| | - Hiroyuki Adachi
- Department of Pediatrics, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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Van Gilst D, Puchkina AV, Roelants JA, Kervezee L, Dudink J, Reiss IKM, Van Der Horst GTJ, Vermeulen MJ, Chaves I. Effects of the neonatal intensive care environment on circadian health and development of preterm infants. Front Physiol 2023; 14:1243162. [PMID: 37719464 PMCID: PMC10500197 DOI: 10.3389/fphys.2023.1243162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
The circadian system in mammals ensures adaptation to the light-dark cycle on Earth and imposes 24-h rhythmicity on metabolic, physiological and behavioral processes. The central circadian pacemaker is located in the brain and is entrained by environmental signals called Zeitgebers. From here, neural, humoral and systemic signals drive rhythms in peripheral clocks in nearly every mammalian tissue. During pregnancy, disruption of the complex interplay between the mother's rhythmic signals and the fetal developing circadian system can lead to long-term health consequences in the offspring. When an infant is born very preterm, it loses the temporal signals received from the mother prematurely and becomes totally dependent on 24/7 care in the Neonatal Intensive Care Unit (NICU), where day/night rhythmicity is usually blurred. In this literature review, we provide an overview of the fetal and neonatal development of the circadian system, and short-term consequences of disruption of this process as occurs in the NICU environment. Moreover, we provide a theoretical and molecular framework of how this disruption could lead to later-life disease. Finally, we discuss studies that aim to improve health outcomes after preterm birth by studying the effects of enhancing rhythmicity in light and noise exposure.
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Affiliation(s)
- D. Van Gilst
- Department of Molecular Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - A. V. Puchkina
- Department of Developmental Biology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. A. Roelants
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - L. Kervezee
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - J. Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - I. K. M. Reiss
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - G. T. J. Van Der Horst
- Department of Molecular Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - M. J. Vermeulen
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - I. Chaves
- Department of Molecular Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
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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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Effect of a light-darkness cycle on the body weight gain of preterm infants admitted to the neonatal intensive care unit. Sci Rep 2022; 12:17569. [PMID: 36266474 PMCID: PMC9584226 DOI: 10.1038/s41598-022-22533-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/17/2022] [Indexed: 01/13/2023] Open
Abstract
The Continuous bright light conditions to which premature infants are subjected while hospitalized in Neonatal Intensive Care Units (NICU) can have deleterious effects in terms of growth and development. This study evaluates the benefits of a light/darkness cycle (LDC) in weight and early hospital discharge from the NICU. Subjects were recruited from three participating institutions in Mexico. Eligible patients (n = 294) were premature infants who were hospitalized in the low-risk and high-risk neonatal units classified as stable. The subjects randomized to the experimental group (n = 150) were allocated to LDC conditions are as follows: light from 07:00 to 19:00 and darkness (25 lx) from 19:00 to 07:00. The control group (n = 144) was kept under normal room light conditions (CBL) 24 h a day. Main outcome was weight gain and the effect of reducing the intensity of nocturnal light in development of premature infants. Infants to the LDC gained weight earlier, compared with those randomized to CBL, and had a significant reduction in length of hospital stay. These results highlight those premature infants subjected to a LDC exhibit improvements in physiological development, favoring earlier weight gain and consequently a decrease in hospital stays. ClinicalTrials.gov; 02/09/2020 ID: NCT05230706.
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Arayici S, Simsek GK, Uras N, Oncel MY, Canpolat FE, Oguz SS. Cycled Lighting Versus Continuous Near Darkness in Preterm Infants: A Randomized Controlled Trial. KLINISCHE PADIATRIE 2021; 234:74-80. [PMID: 34470064 DOI: 10.1055/a-1554-5699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the effectiveness of cycled lighting (CL) or continuous near darkness (CND) on weight in preterm infants. STUDY DESIGN Total 147 infants with a gestational age 25-32 weeks and/or a birth weight 750-1500 g were included in the study. The infants were classified into two groups: CL and CND. Weight on postnatal day 14, weight at corrected 35 weeks, mean rectal temperature and serum growth hormone, cortisol, melatonin levels at 35 weeks' post menstrual age (PMA), weekly weight gain, full enteral feeding time, duration of mechanical ventilation, retinopathy of prematurity (ROP), length of stay in the hospital, weight and length at three and six months corrected age were compared between the groups. RESULTS There were no differences between weights on postnatal day 14. Anthropometric parameters and mean rectal temperatures of groups also were not different at 35 weeks' PMA. There were no differences among the groups in duration of full enteral feeding time, length of stay in hospitalization, duration of mechanical ventilation, ROP and anthropometric parameters. Further, serum growth hormone, cortisol, and melatonin levels were similar between the groups at 35 weeks' PMA. CONCLUSION CL and CND did not have any advantages over each other.
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Affiliation(s)
- Sema Arayici
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Nurdan Uras
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Mehmet Yekta Oncel
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey
| | - Fuat Emre Canpolat
- Division of Neonatology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Serife Suna Oguz
- Division of Neonatology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
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Development of the circadian system and relevance of periodic signals for neonatal development. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:249-258. [PMID: 34225966 DOI: 10.1016/b978-0-12-819975-6.00015-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Circadian rhythms are generated endogenously with a period of approximately 24h. Studies carried out during the last decade indicate that the circadian system develops before birth, and that the suprachiasmatic nucleus, a structure that is considered the mammalian circadian clock, is present in primates from the middle of pregnancy. Recent evidence shows that the infants' circadian system is sensitive to light from very early stages of development; it has also been proposed that low-intensity lighting can regulate the developing clock. After birth there is a progressive maturation of the outputs of the circadian system with marked rhythms in sleep-wake phenomena and hormone secretion. These facts express the importance of circadian photic regulation in infants. Thus, the exposure of premature babies to light/dark cycles results in a rapid establishment of activity/rest patterns, which are in the light-dark cycle. With the continuous study of the development of the circadian system and the influence on human physiology and disease, it is anticipated that the application of circadian biology will become an increasingly important component in the perinatal care.
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Zores‐Koenig C, Kuhn P, Caeymaex L, Allen A, Berne‐Audeoud F, Bouvard C, Brandicourt A, Casper C, Denoual H, Duboz MA, Evrard A, Fichtner C, Fischer‐Fumeaux C, Girard L, Gonnaud F, Haumont D, Hüppi P, Knezovic N, Laprugne‐Garcia E, Legouais S, Mons F, Pelofy V, Picaud J, Pierrat V, Pladys P, Renaud A, Renesme L, Sizun J, Souet G, Thiriez G, Tourneux P, Touzet M, Truffert P, Zaoui C, Zana‐Taieb E. Recommendations on neonatal light environment from the French Neonatal Society. Acta Paediatr 2020; 109:1292-1301. [PMID: 31955460 DOI: 10.1111/apa.15173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/13/2020] [Indexed: 01/21/2023]
Abstract
AIM Hospital light may affect neonatal neurosensory development and the well-being of parents and caregivers. We aimed to issue practical recommendations regarding the optimal light environment for neonatal units. METHODS A systematic evaluation was performed using PubMed to identify relevant papers published in English or French up to July 2018, and the different grades of evidence were evaluated. RESULTS We identified 89 studies and one meta-analysis and examined 31 eligible studies. The major results were that natural or artificial light should not exceed 1000 lux and that all changes in light level should be gradual. Light protection should be used for infants of <32 weeks of postmenstrual age and but must be individualised to each infant. Infants should not be exposed to continuous high light levels regardless of their term and postnatal age. Cycled light before discharge seemed to be safe and beneficial. For medical caregivers' well-being, higher light levels and access to natural light are recommended. Special attention should be given to protecting neonatal patients from high light levels that may be necessary when performing specific care procedures. CONCLUSION Consideration of general principles and practical applications can improve the neonatal light environment for newborn infants, parents and caregivers.
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Affiliation(s)
- Claire Zores‐Koenig
- Médecine et Réanimation du Nouveau‐né Hôpital de Hautepierre CHU Strasbourg Strasbourg France
- Institut des Neurosciences Cellulaires et Intégratives UPR 3212 CNRS et Université de Strasbourg Strasbourg France
| | - Pierre Kuhn
- Médecine et Réanimation du Nouveau‐né Hôpital de Hautepierre CHU Strasbourg Strasbourg France
- Institut des Neurosciences Cellulaires et Intégratives UPR 3212 CNRS et Université de Strasbourg Strasbourg France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal de Créteil Créteil France
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Barone I, Hawks-Mayer H, Lipton JO. Mechanisms of sleep and circadian ontogeny through the lens of neurodevelopmental disorders. Neurobiol Learn Mem 2019; 160:160-172. [DOI: 10.1016/j.nlm.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 12/20/2022]
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Effects of Cycled Lighting Versus Continuous Near Darkness on Physiological Stability and Motor Activity Level in Preterm Infants. Adv Neonatal Care 2017; 17:282-291. [PMID: 27984231 DOI: 10.1097/anc.0000000000000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants generally spend weeks in the neonatal intensive care unit where light intensity can fluctuate as well as be high, leading to physiological instability and increased motor activity in these infants. To date, 2 lighting control methods have been studied: cycled lighting and continuous near darkness. The most appropriate method of lighting is still unknown due to ambivalent results from the studies that have assessed these 2 interventions. OBJECTIVE To compare the effects of cycled lighting versus continuous near darkness on physiological stability and motor activity level in preterm infants born between 28 and 32 weeks of gestation. METHODS A randomized clinical trial was conducted to compare physiological stability and motor activity level in preterm infants assigned to cycled lighting or continuous near darkness. Thirty-eight participants were recruited and randomly assigned to one of the lighting conditions for 24 hours. Physiological stability was measured using the Stability of the Cardiorespiratory System in Premature Infants (SCRIP) score, the means, and the coefficient of variation of each physiological parameter measured. The level of motor activity was measured with an accelerometer. RESULTS There were no significant differences between the 2 groups with regard to physiological stability measured by the SCRIP score, means, and coefficient of variation as well as motor activity level. Participants in both groups were physiologically stable and their motor activity level was comparable. IMPLICATIONS FOR PRACTICE AND RESEARCH Neither cycled lighting nor continuous near darkness negatively impacted infant's physiologic stability and motor activity level. Further research is required to identify the most appropriate lighting control method for preterm infants born between 28 and 32 weeks of gestation.
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Abstract
BACKGROUND Potential benefits and harms of different lighting in neonatal units have not been quantified. OBJECTIVES • To determine effectiveness and safety of cycled light (CL) (approximately 12 hours of light on and 12 hours of light off) for growth in preterm infants at three and six months' corrected age (CA).• In separate analyses, to compare effects of CL with those of irregularly dimmed light (DL) or near darkness (ND), and effects of CL with those of continuous bright light (CBL), on growth in preterm infants at three and six months' CA.• To assess, in subgroup analyses, the effectiveness and safety of CL (vs control interventions (DL, ND and CBL)) introduced at different postmenstrual ages (PMAs) - before 32 weeks', at 32 weeks' and from 36 weeks' PMA - and to compare effectiveness and safety of CL for small for gestational age (GA) infants versus appropriately grown infants. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12), MEDLINE via PubMed (1966 to January 2016), Embase (1980 to January 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 2016). We searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised trials of CL versus ND or CBL in preterm and low birth weight infants. DATA COLLECTION AND ANALYSIS We performed data collection and analyses according to the methods of the Cochrane Neonatal Review Group. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. MAIN RESULTS We identified one additional study enrolling 38 participants for inclusion in this update, for a total of nine studies reporting on 544 infants. In general, the quality of the studies was low, mainly owing to lack of blinding and small sample sizes.Six studies enrolling 424 infants compared CL versus ND. No study reported on weight at three or six months. One study (n = 40) found no statistically significant difference in weight at four months between CL and ND groups. In another study (n = 62), the ratio of day-night activity before discharge favoured the CL group (mean difference (MD) 0.18, 95% confidence interval (CI) 0.17 to 0.19), indicating 18% more activity during the day than during the night in the CL group compared with the ND group. Two studies (n = 189) reported on retinopathy of prematurity (stage ≥ 3) and reported no statistically significant differences between CL and ND groups (typical risk ratio (RR) 0.53, 95% CI 0.25 to 1.11, I(2) = 0%; typical risk difference (RD) -0.09, 95% CI -0.19 to 0.01, I(2) = 0%). Two studies (n = 77) reported length of hospital stay (days) and noted a significant reduction in length of stay between CL and ND groups favouring the CL group (weighted mean difference (WMD) -13 days, 95% CI -23 to -2, I(2) = 0%; no heterogeneity). The quality of the evidence according to GRADE was low for this outcome. One study (n = 37) reported less crying at 11 weeks' corrected age (CA) in the CL group compared with the ND group (MD -0.57 hours/24 h, 95% CI -1.09 to -0.05). Tests for heterogeneity were not applicable.Three studies enrolling 120 infants compared CL versus CBL. Two studies (n = 79) reported significantly shorter length of stay in the CL group compared with the CBL group (WMD -16.5 days, 95% CI -26.2 to -6.8, I(2) = 0%; no heterogeneity). The quality of the evidence according to GRADE was low for this outcome. One study (n = 41) reported higher mean weight at three months' CA among infants cared for in the CL nursery (P value < 0.02) and a lower mean number of hours spent awake in 24 hours at three months of age (P value < 0.005). Data could not be entered into RevMan or GRADE. One study (n = 41) reported shorter time on the ventilator in the CL compared with the CBL group (MD -18.2 days, 95% CI -31.40 to -5.0). One study (n = 41) reported a shorter time to first oral feeding in the CL group (MD -6.8 days, 95% CI -13.29 to -0.31). We identified no safety issues. AUTHORS' CONCLUSIONS Trials assessing the effects of CL have enrolled 544 infants. No study reported on our primary outcome of weight at three or six months. Results from one additional study strengthen our findings that CL versus CBL shortens length of stay, as does CL versus ND. The quality of the evidence on both comparisons for this outcome according to GRADE was low. Future research should focus on comparing CL versus ND.
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Affiliation(s)
- Iris Morag
- The Edmond & Lily Safra Children's Hospital Sheba Medical CenterTel HashomerIsrael
- Tel‐ Aviv UniversitySackler School of MedicineTel‐AvivIsrael
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and EvaluationTorontoCanada
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Navarrete E, Ortega-Bernal JR, Trejo-Muñoz L, Díaz G, Montúfar-Chaveznava R, Caldelas I. Participation of the Olfactory Bulb in Circadian Organization during Early Postnatal Life in Rabbits. PLoS One 2016; 11:e0156539. [PMID: 27305041 PMCID: PMC4909232 DOI: 10.1371/journal.pone.0156539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/16/2016] [Indexed: 12/26/2022] Open
Abstract
Experimental evidence indicates that during pre-visual stages of development in mammals, circadian regulation is still not under the control of the light-entrainable hypothalamic pacemaker, raising the possibility that the circadian rhythmicity that occurs during postnatal development is under the control of peripheral oscillators, such as the main olfactory bulb (MOB). We evaluated the outcome of olfactory bulbectomy on the temporal pattern of core body temperature and gross locomotor activity in newborn rabbits. From postnatal day 1 (P1), pups were randomly assigned to one of the following conditions: intact pups (INT), intact pups fed by enteral gavage (INT+ENT), sham operated pups (SHAM), pups with unilateral lesions of the olfactory bulb (OBx-UNI), and pups with bilateral lesions of the olfactory bulb (OBx-BI). At the beginning of the experiment, from P1-8, the animals in all groups were fed at 11:00, from P9-13 the feeding schedule was delayed 6 h (17:00), and finally, from P14-15 the animals were subjected to fasting conditions. The rabbit pups of the INT, INT+ENT, SHAM and OBx-UNI groups exhibited a clear circadian rhythmicity in body temperature and locomotor activity, with a conspicuous anticipatory rise hours prior to the nursing or feeding schedule, which persisted even during fasting conditions. In addition, phase delays in the nursing or feeding schedule induced a clear phase shift in both parameters. In contrast, the OBx-BI group exhibited atypical rhythmicity in both parameters under entrained conditions that altered the anticipatory component, as well as deficient phase control of both rhythms. The present results demonstrate that the expression of circadian rhythmicity at behavioral and physiological levels during early stages of rabbit development largely depends on the integrity of the main olfactory bulb.
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Affiliation(s)
- Erika Navarrete
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Juan Roberto Ortega-Bernal
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Lucero Trejo-Muñoz
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Georgina Díaz
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Ivette Caldelas
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
- * E-mail:
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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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Light and maternal influence in the entrainment of activity circadian rhythm in infants 4-12 weeks of age. Sleep Biol Rhythms 2016; 14:249-255. [PMID: 27453687 DOI: 10.1007/s41105-015-0046-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The influence of light and maternal activity on early infant activity rhythm were studied in 43 healthy, maternal-infant pairs. Aims included description of infant and maternal circadian rhythm of environmental light, assessing relations among of activity and light circadian rhythm parameters, and exploring the influence of light on infant activity independent of maternal activity. Three-day light and activity records were obtained using actigraphy monitors at infant ages 4, 8, and 12 weeks. Circadian rhythm timing, amplitude, 24-hour fit, rhythm center, and regularity were determined using cosinor and nonparametric circadian rhythm analyses (NPCRA). All maternal and infant circadian parameters for light were highly correlated. When maternal activity was controlled, the partial correlations between infant activity and light rhythm timing, amplitude, 24-hour fit, and rhythm center demonstrated significant relation (r = .338 to .662) at infant age 12 weeks, suggesting entrainment. In contrast, when maternal light was controlled there was significant relation between maternal and infant activity rhythm (r = 0.470, 0.500, and 0.638 at 4, 8 and 12 weeks, respectively) suggesting the influence of maternal-infant interaction independent of photo entrainment of cycle timing over the first 12 weeks of life. Both light and maternal activity may offer avenues for shaping infant activity rhythm during early infancy.
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Mata-Sotres JA, Martínez-Rodríguez G, Pérez-Sánchez J, Sánchez-Vázquez FJ, Yúfera M. Daily rhythms of clock gene expression and feeding behavior during the larval development in gilthead seabream,Sparus aurata. Chronobiol Int 2015; 32:1061-74. [DOI: 10.3109/07420528.2015.1058271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND The potential benefits and harms of different lighting in neonatal units have not been quantified. OBJECTIVES To compare the effectiveness of cycled lighting (CL) (approximately 12 hours of light on and 12 hours of light off) with irregularly dimmed light (DL) or near darkness (ND) and with continuous bright light (CBL) on growth in preterm infants at three and six months of age. SEARCH METHODS We conducted electronic searches of the literature (in January 2013) of the Cochrane Central Register of Controlled Trials, Issue 12, 2012 (CENTRAL), MEDLINE, EMBASE, CINAHL and abstracts from Pediatric Academic Societies' annual meetings. We searched Controlled-trials.com and Clinicaltrials.gov for ongoing trials and abstracts from the Pediatric Academic Societies (PAS) Annual Meetings (2000 to 2013) using the Abstracts2view website on 10 May 2013. SELECTION CRITERIA Randomized or quasi-randomised trials of CL versus ND or CBL in preterm and low birth weight infants. DATA COLLECTION AND ANALYSIS We performed data collection and analyses according to the methods of the Cochrane Neonatal Review Group. MAIN RESULTS Six studies enrolling 424 infants compared CL versus ND (including one additional trial identified in this update that enrolled 37 infants). No study reported on weight at three or six months. In one study (n = 40), there was no statistically significant difference in weight at four months between the CL and ND groups. In another study (n = 62), the ratio of day-night activity prior to discharge favoured the CL group (mean difference (MD) 0.18, 95% confidence interval (CI) 0.17 to 0.19) indicating 18% more activity during the day than during the night in the CL group compared with the ND group. Two studies (n = 189) reported on retinopathy of prematurity (stage ≥ 3). There was no statistically significant difference between the CL and ND groups (typical risk ratio (RR) 0.53, 95% CI 0.25 to 1.11, I(2) = 0%; typical risk difference (RD) -0.09, 95% CI -0.19 to 0.01, I(2) = 0%). Two studies (n = 77) reported on length of hospital stay (days). There was a significant reduction in the length of stay between the CL and the ND groups favouring the CL group (MD -13 days, 95% CI -2 to -23). One study (n = 37) reported on less crying at 11 weeks' corrected age (CA) in the CL group compared with the ND group (MD -0.57 hours/24 hours, 95% CI -1.09 to -0.05).There was no heterogeneity for this outcome (I(2) = 0%).Two studies enrolling 82 infants compared CL versus CBL. One study (n = 41) reported higher mean weight at three months' CA in infants cared for in the CL nursery (P value < 0.02) and lower mean number of hours spent awake in 24 hours at three months of age (P value < 0.005). One study (n = 41) reported shorter time on ventilator in the CL compared with the CBL group (MD -18.2 days, 95% CI -31.40 to -5.0). One study (n = 41) reported a shorter time to first oral feeding in the CL group (MD -6.8 days, 95% CI -13.29 to -0.31).For many outcomes, the trends favoured CL versus ND as well as CL versus CBL.We identified no safety issues. AUTHORS' CONCLUSIONS Trials assessing the effect of CL have enrolled 506 infants. Trends for many outcomes favoured CL compared with ND and CL compared with CBL. The studies may have lacked significance due to a lack of statistical power. Future research should focus on comparing CL to ND.
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Affiliation(s)
- Iris Morag
- The Edmond & Lily Safra Children's Hospital Sheba Medical Center, Tel Hashomer, Israel
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Human colostrum melatonin exhibits a day-night variation and modulates the activity of colostral phagocytes. J Appl Biomed 2013. [DOI: 10.2478/v10136-012-0039-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Hoppenbrouwers T, Oliveira F, Sandarupa S, Khoo M, Neuman M, Ramanathan R. The development of the circadian heart rate rhythm (CHR) in Asian infants. Early Hum Dev 2012; 88:555-61. [PMID: 22289413 PMCID: PMC4490788 DOI: 10.1016/j.earlhumdev.2011.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 12/08/2011] [Accepted: 12/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that term-born Asian infants, at reduced risk to die of Sudden Infant Death Syndrome (SIDS) exhibit a circadian heart rate rhythm (CHR) at a later age than non-Asian term infants. METHOD Repeated overnight heart rate (HR) traces obtained with a battery-operated Polar S810i heart-rate monitor at home in 17 Asian Torajan infants in Indonesia, were compared with those of 52 non-Asian infants monitored as part of the Collaborative Home Infant Monitoring Evaluation (CHIME). HR was determined using a moving window averaging technique. A comparison of median HR during quiet sleep (QS) episodes (identified by minimum HR variability), established the presence of CHR. RESULTS Seventy three percent of non-Asian CHIME infants ≤7 weeks exhibited CHR compared to 45% of Asian Torajan infants. Between 8 and 12 weeks, 94% of non-Asian CHIME infants exhibited CHR, compared to 33% of Asian Torajan infants (p<0.001). Forty seven and 56% of Asian Torajan infants exhibited the CHR at the age intervals of 16-20 weeks and 21-25 weeks respectively. Active wakefulness percentages as a function of the entire recording and median QS HR were not significantly different in the two groups. CONCLUSION Despite the fact that Asian Torajan infants were on average a week older than non-Asian CHIME babies, between two and three months of age only one in three exhibited the CHR, compared to virtually all non-Asian CHIME infants. We speculate that the cause of this difference rests in the infants' environment rather than their genetic origin.
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Affiliation(s)
- Toke Hoppenbrouwers
- University of Southern California Division of Neonatal Medicine, LAC+USC Medical Center and Childrens Hospital Los Angeles, Los Angeles, CA 90033, USA.
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Abstract
BACKGROUND The potential benefits and harms of different lighting in neonatal units have not been quantified. OBJECTIVES To compare the effectiveness of cycled lighting (CL) (approximately 12 hours of light on and 12 hours of light off) with irregularly dimmed light or near darkness (ND) and with continuous bright light (CBL) on growth in preterm infants at three and six months of age. SEARCH STRATEGY Electronic searches of the literature were conducted (in May 2010) of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL and abstracts from Pediatric Academic Societies' annual meetings. SELECTION CRITERIA Randomised or quasi-randomised trials of CL versus ND or CBL in preterm and low birth weight infants. DATA COLLECTION AND ANALYSIS Data collection and analyses were performed according to the methods of the Cochrane Neonatal Review Group. MAIN RESULTS Five studies enrolling 387 infants compared CL to ND. No study reported on weight at three or six months. In one study (n = 40) there was no statistically significant difference in weight at four months between the CL and the ND groups. In another study (n = 62) the ratio of day-night activity prior to discharge favoured the CL group (mean difference 0.18, 95% CI 0.17 to 0.19) indicating 18% more activity during day than night in the CL group compared to the ND group. Two studies (n = 189) reported on retinopathy of prematurity (stage ≥ 3). There was no statistically significant difference between the CL and ND groups (typical RR 0.53, 95% CI 0.25 to 1.11, I(2) = 0%; typical RD -0.09, 95% CI -0.19 to 0.01, I(2) = 0%).Two studies enrolling 82 infants compared CL to CBL. One study (n = 41) reported higher mean weight at three months corrected age in infants cared for in the CL nursery (P < 0.02) and lower mean number of hours spent awake in 24 hours at three months (P < 0.005). In one study (n = 41) days on a ventilator were reduced in the CL group (mean difference -18, 95% CI -31 to -5 days).For many outcomes the trends favoured CL versus ND as well as CL versus CBL. AUTHORS' CONCLUSIONS Trials assessing the effect of CL have enrolled 469 infants. Trends for many outcomes favoured cycled light (CL) compared to near darkness (ND) and CL compared to continuous bright light (CBL) The studies may have lacked significance due to a lack of statistical power. Future research should focus on comparing CL to ND.
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Affiliation(s)
- Iris Morag
- Neonatal Unit, Mayanei HaYeshua Medical Centre, Bnei Brak, Israel
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Energy expenditure and physical activity in recovering malnourished infants. J Nutr Metab 2010; 2010. [PMID: 20700406 PMCID: PMC2911605 DOI: 10.1155/2010/171490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/29/2009] [Accepted: 12/01/2009] [Indexed: 11/17/2022] Open
Abstract
Background. Malnourished infants are small for age and weight. Objectives. Determine profiles in 24-hour energy metabolism in recovering malnourished infants and compare to similarly aged healthy controls. Methods. 10 malnourished infants (58.1 +/- 5.9 cm, 7.7 +/- 5.6 months) were healthy prior to spending 22 hours in the Enhanced Metabolic Testing Activity Chamber for measurement of EE (kcal/min), sleeping metabolic rate (SMR; kcal/min), respiratory quotient (RQ; VCO(2)/VO(2)), and physical activity (PA; oscillations in wt/min/kg body weight). Metabolic data were extrapolated to 24 hours (kcal/kg/d). Energy intake (kcal/kg/d) and the proportions (%) of carbohydrate, protein, and fat were calculated. Anthropometrics for malnourished infants were obtained. Statistical differences (P < .05) between groups were determined (SPSS, version 13). Results. In comparison to controls, malnourished infants were lighter (4.1 +/- 1.2 versus 7.3 +/- 0.8 kg; P < .05), had less body fat % (10.3 +/- 7.6 versus 25.7 +/- 2.5), and lower BMI (12.0 +/- 1.7 versus 15.5 +/- 1.5; P < .05). In contrast, they had greater energy intake (142.7 +/- 14.6 versus 85.1 +/- 25.8; P < .05) with a greater percentage of carbohydrates (55.1 +/- 3.9 versus 47.2 +/- 5.2; P < .05). However, malnourished infants had greater 24-hour EE (101.3 +/- 20.1 versus 78.6 +/- 8.4; P < .05), SMR (92.6 +/- 17.1 versus 65.0 +/- 3.9; P < .05), and RQ (1.00 +/- 0.13 versus 0.86 +/- 0.08; P < .05) along with a lower amount of PA (2.3 +/- 0.94 versus 4.0 +/- 1.5; P < .05). Conclusions. Malnourished infants require more energy, possibly for growth.
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Wunderlich JE, Needleman BJ, Chen Z, Yu JG, Wang Y, Grants I, Mikami DJ, Melvin WS, Cooke HJ, Christofi FL. Dual purinergic synaptic transmission in the human enteric nervous system. Am J Physiol Gastrointest Liver Physiol 2008; 294:G554-66. [PMID: 18079280 DOI: 10.1152/ajpgi.00500.2007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Based on findings in rodents, we sought to test the hypothesis that purinergic modulation of synaptic transmission occurs in the human intestine. Time series analysis of intraneuronal free Ca(2+) levels in submucosal plexus (SMP) from Roux-en-Y specimens was done using Zeiss LSM laser-scanning confocal fluo-4 AM Ca(2+) imaging. A 3-s fiber tract stimulation (FTS) was used to elicit a synaptic Ca(2+) response. Short-circuit current (I(sc) = chloride secretion) was recorded in mucosa-SMP in flux chambers. A distension reflex or electrical field stimulation was used to study I(sc) responses. Ca(2+) imaging was done in 1,222 neurons responding to high-K(+) depolarization from 61 surgical cases. FTS evoked synaptic Ca(2+) responses in 62% of recorded neurons. FTS caused frequency-dependent Ca(2+) responses (0.1-100 Hz). FTS Ca(2+) responses were inhibited by Omega-conotoxin (70%), hexamethonium (50%), TTX, high Mg(2+)/low Ca(2+) (< or = 100%), or capsaicin (25%). A P2Y(1) receptor (P2Y(1)R) antagonist, MRS-2179 or PLC inhibitor U-73122, blocked FTS responses (75-90%). P2Y(1)R-immunoreactivity occurred in 39% of vasoactive intestinal peptide-positive neurons. The selective adenosine A(3) receptor (AdoA(3)R) agonist 2-chloro-N(6)-(3-iodobenzyl)adenosine-5'-N-methylcarboxamide (2-Cl-IBMECA) caused concentration- and frequency-dependent inhibition of FTS Ca(2+) responses (IC(50) = 8.5 x 10(-8) M). The AdoA(3)R antagonist MRS-1220 augmented such Ca(2+) responses; 2-Cl-IBMECA competed with MRS-1220. Knockdown of AdoA(1)R with 8-cyclopentyl-3-N-(3-{[3-(4-fluorosulphonyl)benzoyl]-oxy}-propyl)-1-N-propyl-xanthine did not prevent 2-Cl-IBMECA effects. MRS-1220 caused 31% augmentation of TTX-sensitive distension I(sc) responses. The SMP from Roux-en-Y patients is a suitable model to study synaptic transmission in human enteric nervous system (huENS). The P2Y(1)/Galphaq/PLC/inositol 1,3,5-trisphosphate/Ca(2+) signaling pathway, N-type Ca(2+) channels, nicotinic receptors, and extrinsic nerves contribute to neurotransmission in huENS. Inhibitory AdoA(3)R inhibit nucleotide or cholinergic transmission in the huENS.
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Affiliation(s)
- J E Wunderlich
- Department of Anesthesiology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
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Affiliation(s)
- Scott A Rivkees
- Department of Pediatrics, Yale Child Health Research Center, Yale University, New Haven CT
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Abstract
Recent evidence shows that the circadian system of primate infants is responsive to light at very premature stages and that low intensity lighting can regulate the developing clock. After birth, there is progressive maturation of the circadian system outputs, with pronounced rhythms in sleep-wake and hormone secretion generally developing after 2 months of age. Showing the importance of photic regulation of circadian phase in infants, exposure of premature infants to low-intensity cycled lighting results in the early establishment of rest-activity patterns that are in phase with the 24-hour light-dark cycle. With the continued elucidation of circadian system development and influences on human physiology and illness, it is anticipated that consideration of circadian biology will become an increasingly important component of neonatal care.
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Affiliation(s)
- Scott A Rivkees
- Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, P.O. Box 208081, New Haven, CT 06510, USA.
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Oliveira HA, Moreira AJP, Oliveira AMP. Ritmo circadiano e doença vascular encefálica: um estudo de correlação com fatores de risco. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:292-6. [PMID: 15235733 DOI: 10.1590/s0004-282x2004000200018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Os mecanismos biológicos humanos exibem variabilidade clínica previsível no tempo, o que tem permitido reavaliação das práticas médicas atuais, do estudo mais aprofundado do ritmo circadiano (RC) e dos mecanismos que geram as oscilações sustentadas em todos os níveis biológicos. Fizemos um estudo procurando relacionar o RC e o momento do aparecimento do quadro clínico neurológico decorrente da lesão vascular do encéfalo com os fatores de risco modificáveis identificados no momento da internação. Foram estudados 53 pacientes, sendo 50,94% (n =27) do sexo feminino e 49,50%(n =26) do masculino, com média de idade de 66,4 anos. Quatro intervalos de 6 horas (0-6; 6-12; 12-18; 18-24) foram usados para análise da freqüência do ictus e da incidência em cada intervalo. Os resultados mostraram 6 (11,32%) pacientes no intervalo 0-6 hs; 21 (39,62%) no intervalo 6-12 hs; 10 (18,86%) no intervalo 12-18 hs; 16 (30,18%) no intervalo 18-24 hs. Estudo de correlação com os fatores de risco, baseado nos dados clínicos no momento da internação, mostrou que a hipertensão arterial [(81,25%)] e o tabagismo[ (56,25%)] predominaram no intervalo 18-24 hs, enquanto o sedentarismo[11; (52,38%)] o estresse[11 (52,38%)] o diabetes [(47,61%)] a hiperlipidemia [8 (38,09%)] e o alcoolismo[8 (38,09%)] predominaram no intervalo 6-12 hs; as cardiopatias [(50,00%)] predominaram no intervalo de 12-18 hs.
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Affiliation(s)
- Helio Araújo Oliveira
- Serviço de Neurologia, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, SE, Brasil.
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Shepley MM. Evidence-based design for infants and staff in the neonatal intensive care unit. Clin Perinatol 2004; 31:299-311, vii. [PMID: 15289034 DOI: 10.1016/j.clp.2004.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conscientious architects are becoming increasingly aware of the impact of design decisions on the sensory environment of the neonatal intensive care unit (NICU). This article addresses the relevance of theories of environmental psychology to NICU design. Design research on infants and staff in NICUs is summarized, and future research directions are identified.
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Rivkees SA, Mayes L, Jacobs H, Gross I. Rest-activity patterns of premature infants are regulated by cycled lighting. Pediatrics 2004; 113:833-9. [PMID: 15060235 DOI: 10.1542/peds.113.4.833] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Many hospitalized premature infants are exposed to continuous dim lighting rather than to cycled lighting. However, we do not know whether dim lighting or low-intensity cycled lighting is more conducive to the development of rest-activity patterns that are in phase with the solar light-dark cycle. Thus, we examined the effects of nursery lighting conditions on the development of activity patterns in premature infants. METHODS Premature infants who were born at <32 weeks' postmenstrual age and were medically stable in neonatal intensive care unit rooms were randomly assigned between 32 and 34 weeks' postmenstrual age to either continuous dim lighting (<25 lux; duration 24 days; control group; n = 29) or cycled lighting (239 +/- 29 lux, 7:00 AM to 7:00 PM; <25 lux, 7:00 PM to 7:00 AM; duration: 25 days; experimental group; n = 33). Activity was continuously monitored from enrollment until approximately 1 month after discharge from the hospital. Weight and head circumference were also assessed up to 6 months after discharge from the hospital. RESULTS Over the first 10 days at home, distinct day-night differences in activity were not seen in control subjects (D day-night: N 1.07 +/- 0.02), but experimental group infants were more active during the day than at night (day-night: 1.25 +/- 0.03). It was not until 21 to 30 days after discharge that day-night activity ratios in control infants matched those seen in experimental group infants shortly after discharge, yet even at this age, experimental group infants (day-night: 2.13 +/- 0.19) were considerably more active during the day than at night as compared with control subjects (day-night: 1.43 +/- 0.09). CONCLUSION Exposure of premature infants to low-intensity cycled lighting in the hospital nursery induces distinct patterns of rest-activity that are apparent within 1 week after discharge. In comparison, the appearance of distinct patterns of rest and activity are delayed in infants who are exposed to continuous dim lighting in the hospital. These observations show that day-night rhythms in activity patterns can be detected shortly after discharge to home in premature infants and that the circadian clock of developing infants is entrained by cycled lighting.
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Affiliation(s)
- Scott A Rivkees
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8081, USA.
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Abstract
AIMS To evaluate whether maternal blood cortisol acts as an entrainer of the fetus, we compared diurnal variations in the fetal heart rate (FHR) of two cases with Cushing's syndrome, under condition of glucocorticoid replacement therapy after adrenalectomy. SUBJECTS The Maternal cortisol concentration in Case 1 showed bimodal change, at 31 and 38 weeks' gestation, while the concentration in Case 2 was found to have an abnormally high level with no diurnal variation at 30 weeks and a monomodal pattern at 34 weeks. RESULTS The FHR patterns in both cases demonstrated similar developmental change: a remarkable diurnal rhythm comparable to control cases was observed at 34-38 weeks. Analysis of spectral 1/f characteristics revealed, however, that Case 1 exhibited a pattern equivalent to control cases, whereas in Case 2, FHR values did not display overt diurnal variation. CONCLUSIONS The diurnal rhythm of FHR develops irrespective of daily variation in maternal cortisol concentration.
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Affiliation(s)
- Naoki Horimoto
- Department of Human Development, Graduate School of Medical Sciences, Kyushu University, Japan.
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29
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Abstract
Circadian rhythms are endogenously generated rhythms with a period length of approximately 24 hours. Evidence gathered during the past decade indicates that the circadian timing system develops prenatally and the suprachiasmatic nuclei, the site of a circadian clock, is present by midgestation in primates. Recent evidence also shows that the circadian system of primate infants is responsive to light at very premature stages and that low-intensity lighting can regulate the developing clock. After birth, there is progressive maturation of the circadian system outputs, with pronounced rhythms in sleep-wake and hormone secretion generally developing after 2 months of age. Showing the importance of photic regulation of circadian phase in infants, exposure of premature infants to low-intensity cycled lighting results in the early establishment of rest-activity patterns that are in phase with the 24-hour light-dark cycle. With the continued elucidation of circadian system development and influences on human physiology and illness, it is anticipated that consideration of circadian biology will become an increasingly important component of neonatal care.
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Affiliation(s)
- Scott A Rivkees
- Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Warren I. Facilitating infant adaptation: the nursery environment. SEMINARS IN NEONATOLOGY : SN 2002; 7:459-67. [PMID: 12614598 DOI: 10.1053/siny.2002.0151] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The physical and social environment of the nursery is a direct and indirect influence on the development of premature infants. Qualities in the environment affect physiological stability and provide sensory experience that is relevant to brain development. Adaptation of the prematurely born infant to the unexpected surroundings of the neonatal intensive care unit can be facilitated when the infant's developmental needs are understood and characteristics of the environment are adapted accordingly. The need for environmental change is revealed by the infant's behaviour, that is, his interactions with the environment. The environment also affects the behaviour of caregivers, who like the baby need to be able to do their best in this challenging situation.
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Affiliation(s)
- Inga Warren
- Winnicott Baby Unit, St Mary's NHS Trust, London, UK.
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Ferber SG, Laudon M, Kuint J, Weller A, Zisapel N. Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. J Dev Behav Pediatr 2002; 23:410-5. [PMID: 12476070 DOI: 10.1097/00004703-200212000-00003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to investigate the effect of massage therapy on phase adjustment of rest-activity and melatonin secretion rhythms to the nocturnal period in full-term infants. Rest-activity cycles of infants (measurement 1, n = 16) were measured by actigraphy before and after 14 days of massage therapy (starting at age 10 [+/-4] d) and subsequently at 6 and 8 weeks of age. 6-Sulphatoxymelatonin excretion was assessed in urine samples at 6, 8, and 12 weeks of age (measurement 2, n = 21). At 8 weeks the controls revealed one peak of activity at approximately 12 midnight (11 p.m.-3 a.m.) and another one at approximately 12 noon (11 a.m.-3 p.m.), whereas in the treated group, a major peak was early in the morning (3 a.m.-7 a.m.) and a secondary peak in the late afternoon (3 p.m.-7 p.m.). At 12 weeks, nocturnal 6-sulphatoxymelatonin excretions were significantly higher in the treated infants (1346.38 +/- 209.40 microg/night vs 823.25 +/- 121.25 microg/night, respectively; <.05). It is concluded that massage therapy by mothers in the perinatal period serves as a strong time cue, enhancing coordination of the developing circadian system with environmental cues.
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Affiliation(s)
- Sari Goldstein Ferber
- Department of Neonatology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv.
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Abstract
The suprachiasmatic nucleus (SCN) is the site of the generation and entrainment of circadian rhythms. Similar to other structures, it develops throughout gestation but is still immature for some time after. This suggests that the SCN could be vulnerable to maternal influences, such as poor nutrition, stress and drugs, all of which can affect neuronal development. Evidence is accumulating that suggests that this is the case, with body size at birth influencing melatonin production in adult humans and maternal malnutrition, and stress affecting sleep in rodents. Interestingly, the maternal environment affects the phase of rhythms and the response of the circadian timing system to light pulses. The nature of these changes in adult rhythmicity is similar to those commonly associated with depression in humans. Thus, abnormal fetal programming might predispose adults to depressive illness.
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Affiliation(s)
- David J Kennaway
- Dept Obstetrics and Gynaecology, University of Adelaide, Medical School, Frome Road, 5005, Adelaide, Australia.
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Bolt RJ, van Weissenbruch MM, Lafeber HN, Delemarre-van de Waal HA. Development of the hypothalamic-pituitary-adrenal axis in the fetus and preterm infant. J Pediatr Endocrinol Metab 2002; 15:759-69. [PMID: 12099385 DOI: 10.1515/jpem.2002.15.6.759] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of the hypothalamic-pituitary-adrenal (HPA) axis in the human fetus is a complex process. The feto-placental unit may be responsible for important maturational processes in vital organ systems in the fetus. A late gestational cortisol surge may be important in fetal maturation, particularly maturation of the lungs. Several striking differences exist between the function of the HPA axis in the fetus and in adults, such as a relative deficiency of 3beta-hydroxysteroid dehydrogenase in the fetal adrenal cortex. With the transition from intrauterine to extra-uterine life several changes occur in the function of the HPA axis. In infants born before term, the function of the HPA axis may still be immature at both the central and adrenal level. This immaturity of the HPA axis may be important in the development of neonatal morbidity. The present review describes the development of the HPA axis in the fetus and in preterm infants and discusses the possible role of HPA immaturity in the development of neonatal morbidity.
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Affiliation(s)
- R J Bolt
- Research Institute Endocrinology, Reproduction and Metabolism, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Brandon DH, Holditch-Davis D, Belyea M. Preterm infants born at less than 31 weeks' gestation have improved growth in cycled light compared with continuous near darkness. J Pediatr 2002; 140:192-9. [PMID: 11865270 DOI: 10.1067/mpd.2002.121932] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our purpose was to evaluate the benefits of cycled light (CL) versus near darkness (ND) on health in preterm infants born at <31 weeks' gestational age. STUDY DESIGN Randomized, interventional study comparing infants receiving (1) CL from birth, (2) CL at 32 weeks' postconceptional age (PCA), and (3) CL at 36 weeks' PCA in transition for discharge home. Statistical significance was assessed with segmented mixed general linear models, analysis of covariance, general estimating equations, chi(2), and Fisher's exact procedure. RESULTS Infants receiving CL at birth and 32 weeks' PCA gained weight faster than infants not receiving CL until 36 weeks' PCA. There were no differences among the groups in length of hospitalization stay or number of ventilator days, but the power was low for these variables. CONCLUSIONS These findings suggest that CL has significant weight gain benefits over ND, and there are no short-term advantages of ND over cycled light for health in preterm infants.
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Affiliation(s)
- Debra H Brandon
- Duke University School of Nursing, Duke Perinatal Research Institute, Durham, North Carolina 27710, USA
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Serón-Ferré M, Torres C, Parraguez VH, Vergara M, Valladares L, Forcelledo ML, Constandil L, Valenzuela GJ. Perinatal neuroendocrine regulation. Development of the circadian time-keeping system. Mol Cell Endocrinol 2002; 186:169-73. [PMID: 11900892 DOI: 10.1016/s0303-7207(01)00682-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During gestation, the perinatal neuroendocrine axis keeps clock time. In primates, the suprachiasmatic nucleus (biological clock in mammals), shows oscillatory function by midgestation. There is evidence in rodents that the mother, during pregnancy, entrains the fetal suprachiasmatic nucleus (SCN) and newborn circadian rhythms. We are investigating the role of maternal melatonin as an entraining signal for the newborn circadian time-keeping system in the Cebus apella (New World non-human primate). Twenty-four hour rhythms of temperature and cortisol are present in the 4 days old C. apella newborn. Preliminary data suggests that inhibition of maternal melatonin by exposing pregnant females to constant light alters these rhythms. We have found binding sites for melatonin and expression of mRNA for Mel 1A receptor in hypothalamus, kidney and testis. These preliminary results suggest that maternal melatonin may play a role in relating the perinatal circadian time-keeping system to environmental signals.
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Affiliation(s)
- María Serón-Ferré
- Departamento de Ciencias Fisiológicas, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Casilla 114-D, Santiago, Chile.
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Abstract
The purpose of this study was to describe the circadian rhythm of abdominal skin temperature and explore factors related to the timing of circadian rhythm acrophase. Thirty-four preterm infants (gestational age 26 to 33 weeks) were studied in the home environment at 44 to 46 weeks postconceptional age. Insulated abdominal skin was monitored continuously, and parents recorded sleep/wake activity over a 24-h period. Circadian rhythm was analyzed using cosinor analysis. Using MANCOVA, the effects of cosleeping, feeding method, night feeding, hospital stay, time home, and illness on acrophase were determined. Infants demonstrated evidence of developing circadian rhythm of temperature. Cosleeping and length of hospital stay were significantly related to acrophase. The mean acrophase for cosleeping infants was 07:44 (95% confidence interval = 05:12, 11:08), whereas that for non-cosleeping infants was 22.05 (95% confidence interval = 17:31, 01:42). Proximity with parents during nighttime hours may serve to entrain preterm infant circadian rhythm.
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Affiliation(s)
- Karen A Thomas
- Department of Family and Child Nursing, University of Washington School of Nursing, Seattle 98195-7262, USA.
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Serón-Ferré M, Torres-Farfán C, Forcelledo ML, Valenzuela GJ. The development of circadian rhythms in the fetus and neonate. Semin Perinatol 2001; 25:363-70. [PMID: 11778907 DOI: 10.1053/sper.2001.29037] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The circadian time-keeping system is the neural system that allows predictive adaptation of individuals to the reproducible 24-hour day/night alternations of our planet. A biological clock, the suprachiasmatic nucleus, receives environmental information and imposes a circadian pattern to physiological functions. Since the suprachiasmatic nucleus develops early in gestation and circadian rhythms are present in the fetus and newborn, the circadian system seems to be functional in fetal life and can receive circadian inputs through the mother. The neonate moves to an environment in which the main time giving signal is the light:dark cycle. Teleologically, a term newborn should be fit to face this challenge. But this may be quite different for a preterm infant that trades the circadian environment to which it was previously exposed for the timeless environment of the Neonatal Intensive Care Nursery. Scientists and physicians should seek new experimental and clinical approaches to answer the challenging questions of perinatal chronomedicine.
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Affiliation(s)
- M Serón-Ferré
- Departamento de Ciencias Fisiológicas, Facultad de Cien- cias Biológicas, P. Universidad Católica de Chile.
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Rivkees SA. Arrhythmicity in a child with septo-optic dysplasia and establishment of sleep-wake cyclicity with melatonin. J Pediatr 2001; 139:463-5. [PMID: 11562632 DOI: 10.1067/mpd.2001.117074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We identified a 3-year-old child with septo-optic dysplasia with arrhythmic activity patterns. To assess whether melatonin could improve rest-activity patterns, 0.1 mg was administered orally at 19:00 hours. After therapy onset, normal rest-activity patterns appeared. These observations show that melatonin can restore normal rhythmicity in the absence of a normally functioning circadian clock.
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Affiliation(s)
- S A Rivkees
- Department of Pediatrics, Interdepartmental Neuroscience Program in Neuroscience, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Serón-Ferré M, Riffo R, Valenzuela GJ, Germain AM. Twenty-four-hour pattern of cortisol in the human fetus at term. Am J Obstet Gynecol 2001; 184:1278-83. [PMID: 11349202 DOI: 10.1067/mob.2001.113322] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Indirect evidence suggests that adrenal steroid production in the human fetus may have a circadian rhythm. To assess whether there is a 24-hour rhythm of fetal cortisol in the human fetus, we investigated the relationship between fetal and maternal cortisol and cortisone concentrations in maternal, umbilical arterial, and umbilical venous blood samples over a 24-hour period. STUDY DESIGN Elective cesarean sections were scheduled every 2 hours around the clock in 57 term (38-41 weeks' gestation) nonlaboring pregnant women. Plasma cortisol and cortisone concentrations were measured by high-pressure liquid chromatography. RESULTS The mean 24-hour cortisol concentration was higher in umbilical arterial than in umbilical venous blood samples, 63.6 +/- 4.6 ng/mL (SEM) versus 48.7 +/- 3.2 ng/mL, respectively (P <.05). Fetal plasma cortisol showed a rhythm in the umbilical artery (acme from noon to 4 PM ) (1-way analysis of variance and least significant difference test; P <.05) but not in the umbilical vein. Umbilical arteriovenous differences showed no net transfer of cortisol to the fetus at any time of the day and net fetal production of cortisol from 8 AM to 6 PM. There was limited transfer of cortisone to the fetus and only in the 2 AM -to-noon time interval. CONCLUSION These data suggest the presence of a 24-hour rhythm of fetal adrenal cortisol secretion that may be controlled by a fetal circadian pacemaker.
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Affiliation(s)
- M Serón-Ferré
- Unidad de Reproducción y Desarrollo, Facultad de Ciencas Biológicas, Santiago, Chile
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