Sleep-Wake Transitions in Premature Neonates Predict Early Development
Sleep-Wake Transitions in Premature Neonates Predict Early Development
复制标题
DOI：
10.1542/peds.2011-0047
复制
发表时间：
2011-10-01
期刊：
影响因子：
8
通讯作者：
Feldman, Ruth
中科院分区：
文献类型：
--
作者：
Weisman, Omri;Magori-Cohen, Reuma;Feldman, Ruth
目的：确定新生儿睡眠-觉醒转换的模式，以区分在出生后5年内在多个发育领域表现出更好或更差结局的早产儿。方法：参与者为143名低出生体重儿(平均出生体重1482g；平均胎龄[GA]：31.82周)。在连续4个晚上的4个小时内，观察37周、10秒的睡眠状态，并通过数学聚类进行分析。出院时用新生儿行为评定量表评定神经行为成熟度，3个月、6个月、6个月、6个月、24个月进行情绪调节评估，6、12、24个月进行认知发育评估，5年后进行言语智商、执行功能、象征能力测试。结果：3组婴儿存在3种状态转换模式，出生体重、出生后出生体重、出生体重、出生后出生体重、出生体重、出生后出生体重、出生后出生体重、睡眠状态转换主要表现为从安静睡眠到清醒状态转换的婴儿在5岁时表现出最好的发育，包括更大的新生儿神经成熟度，更少的负面情绪，更好的认知发展，以及更好的言语、象征和执行能力。相比之下，主要在高唤醒状态之间循环的婴儿结果更差。结论：根据状态之间的转换来定义睡眠组织被证明有助于识别新生儿行为中的风险和弹性指标，以预测神经行为、情绪和认知成长的轨迹。儿科2011；128：706-714
OBJECTIVE: To identify patterns of sleep-wake transitions in the neonatal period that might differentiate premature infants who would show better or worse outcomes in multiple developmental domains across the first 5 years of life.METHODS: Participants were 143 low birth weight premature infants (mean birth weight: 1482 g; mean gestational age [GA]: 31.82 weeks). Sleep states were observed at a GA of 37 weeks in 10-second epochs over 4 consecutive evening hours and were analyzed through mathematical clustering. Neurobehavioral maturation was evaluated with the Neonatal Behavior Assessment Scale at discharge, emotional regulation was assessed during infant-mother and infant-father interactions at 3 and 6 months, cognitive development was measured at 6, 12, and 24 months, and verbal IQ, executive functions, and symbolic competence were tested at 5 years.RESULTS: Three types of state-transition patterns were identified, and no differences in birth weight, GA, or medical risk between the 3 groups were found. Infants whose sleep-state transitions were mainly characterized by shifts between quiet sleep and wakefulness exhibited the best development, including greater neonatal neuromaturation, less negative emotionality, better cognitive development, and better verbal, symbolic, and executive competences at 5 years. In comparison, infants who cycled mainly between states of high arousal, such as active sleep and cry, or between short episodes of active and quiet sleep showed poorer outcomes.CONCLUSIONS: Defining sleep organization on the basis of transitions between states proved useful for identifying risk and resilience indicators in neonatal behavior to predict trajectories of neurobehavioral, emotional, and cognitive growth. Pediatrics 2011;128:706-714