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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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Hotta M, Ueda K, Ikehara S, Tanigawa K, Nakayama H, Wada K, Kimura T, Ozono K, Sobue T, Iso H. Association between neonatal phototherapy and sleep: The Japan Environment and Children's Study. J Sleep Res 2023; 32:e13911. [PMID: 37105535 DOI: 10.1111/jsr.13911] [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: 09/26/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
This observational cohort study aimed to evaluate the association between the duration of neonatal phototherapy and sleep-and-wakefulness states at 1 month, 1.5 years, and 3 years of age. We analysed data from 77,876 infants using the Japan Environment and Children's Study, a nationwide birth cohort study. The participants were divided into three groups: no phototherapy, short phototherapy (1-24 h), and long phototherapy (>24 h). Multiple regression analysis was performed to assess the effect of phototherapy duration on infant sleep at each age after adjusting for potential risk factors. A longer duration of phototherapy was associated with a shorter sleep time over 24 h at 1 month of age (β, -0.62; SE, -0.77 to -0.47) when compared with a shorter duration of, or no, phototherapy, following the adjustment of confounding factors. Contrastingly, the short duration group, when compared with the no phototherapy group, was associated with later sleep onset (β, 0.04; SE, 0.00-0.08) and later sleep offset (β, 0.05; SE, 0.01-0.09) at 1.5 years of age. We concluded that the duration of phototherapy may be transiently associated with sleep duration in infants, as emphasised by the shortening of the total sleep time per 24 h at 1 month of age.
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Affiliation(s)
- Masashi Hotta
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kimiko Ueda
- Maternal & Child Health Information Center, Osaka Women's and Children's Hospital, Japan
| | - Satoyo Ikehara
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Kanami Tanigawa
- Maternal & Child Health Information Center, Osaka Women's and Children's Hospital, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Hirofumi Nakayama
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Hiroyasu Iso
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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Koch G, Jost K, Schulzke SM, Koch R, Pfister M, Datta AN. The rhythm of a preterm neonate's life: ultradian oscillations of heart rate, body temperature and sleep cycles. J Pharmacokinet Pharmacodyn 2021; 48:401-410. [PMID: 33523331 DOI: 10.1007/s10928-020-09735-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
The objectives are to characterize oscillations of physiological functions such as heart rate and body temperature, as well as the sleep cycle from behavioral states in generally stable preterm neonates during the first 5 days of life. Heart rate, body temperature as well as behavioral states were collected during a daily 3-h observation interval in 65 preterm neonates within the first 5 days of life. Participants were born before 32 weeks of gestational age or had a birth weight below 1500 g; neonates with asphyxia, proven sepsis or malformation were excluded. In total 263 observation intervals were available. Heart rate and body temperature were analyzed with mathematical models in the context of non-linear mixed effects modeling, and the sleep cycles were characterized with signal processing methods. The average period length of an oscillation in this preterm neonate population was 159 min for heart rate, 290 min for body temperature, and the average sleep cycle duration was 19 min. Oscillation of physiological functions as well as sleep cycles can be characterized in very preterm neonates within the first few days of life. The observed parameters heart rate, body temperature and sleep are running in a seemingly uncorrelated pace at that stage of development. Knowledge about such oscillations may help to guide nursing and medical care in these neonates as they do not yet follow a circadian rhythm.
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Affiliation(s)
- Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, Spitalstrasse 33, 4056, Basel, Switzerland.
| | - Kerstin Jost
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Sven M Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | | | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Alexandre N Datta
- Pediatric Neurology and Developmental Medicine Department, University Children's Hospital Basel UKBB, Basel, Switzerland
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Sleep and prematurity: sleep outcomes in preterm children and influencing factors. World J Pediatr 2019; 15:209-218. [PMID: 30830664 DOI: 10.1007/s12519-019-00240-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep undergoes changes from birth to adulthood, while sleep disorders are associated with various cognitive deficiencies in childhood. In parallel, prematurity is known to predispose to poor neurodevelopmental outcomes. Our aim is to provide literature data about factors influencing sleep in the premature infants and sleep outcomes in this population. METHODS A systematic review was conducted using a variety of health-related databases. Original research papers were considered and no year-of-publication restriction was placed. RESULTS In total, 22 articles fulfilled our selection criteria. Available studies present remarkable heterogeneity in terms of methodological design. Compared to full term, premature infants exhibit significant differences in sleep structure, which mainly include differences in electroencephalographic spectral values, in total sleep time and in arousal threshold. Furthermore, prematurity seems to be a risk factor of sleep breathing disorders in childhood and adolescence. Data about the effect of methylxanthines and the environment of neonatal intensive care unit is controversial. With regard to the impact of prematurity-related sleep disorders on future neurodevelopment, available research papers are generally few. CONCLUSIONS The alterations in sleep patterns are an outcome of prematurity (immaturity of nervous system) as well as of postnatal factors and comorbidities. Sleep problems in this population of infants seems to be a missing piece of the puzzle of impaired neurodevelopment. Future studies should focus on interventions to improve sleep hygiene and limit neurodevelopmental problems.
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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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