Ontogenesis of the Rapid Eye Movement/Non-Rapid Eye Movement Sleep and Waking States in the Human Fetus

1)胎儿瞳孔直径差异有统计学意义，扩瞳组为9.7%，缩瞳组（1.7mm）为90.3%。眼动（EM）期瞳孔扩张比例（14.3%）显著高于无眼动（NEM）期瞳孔扩张比例（2.3%），说明人类足月胎儿瞳孔扩张与眼动期密切相关。2)从EM期开始和第一次排尿之间的时间差分析，72%的排尿发生在37周胎儿EM期开始后的8分钟内。这表明了EM期的开始和之后的第一次排尿之间的时间关系。3)在妊娠29-30周和37-38周出现了EM期持续时间的2个统计学临界点，而在妊娠31-32周和37-38周出现了NEM期持续时间的2个统计学临界点。这些发现表明存在两种独立的机制，一种用于维持新兴市场时期的持续时间，另一种用于维持新市场时期的持续时间。负责EM和NEM周期超节律的切换和维持机制已经成熟。4)我们研究了胎儿行为模式是否可以用来定位产前脑损伤部位。胎儿运动减少，持续无反应性胎心率（FHR）模式，和/或中枢神经系统畸形被用作可能的神经功能障碍的指标。10名符合上述标准的胎儿接受了进一步的超声检查，观察四肢运动、呼吸、眼睛和嘴巴以及活跃/安静的FHR模式。这10个胎儿中有8个在产后检查中被发现有脑损伤。将可能存在宫内脑损伤的胎儿分为4组：(1)病变部位位于脑桥-延髓或脑桥-延髓尾侧，可通过胎儿行为明确识别；(2)脑部弥漫性病变，虽然导致异常行为，但不能通过这种行为定位；(3)病变位于大脑半球，但没有异常行为；(4)子宫内暂时性异常行为，最终转变为正常模式，没有新生儿神经异常。因此，提出了一种产前评估脑损伤的筛查系统。少

1) Fetal pupillary deameters were statistically differ-entiated into two groups : 9.7% for dilated pupil and 90.3% for constricted pupil (1.7mm). The percentage of dilated pupil during the eye movement (EM) period (14.3%) was significantly greater than that during no eye movement (NEM) period (2.3%), thereby indicating a close relation between pupillary dilatation and eye movement periods in the human term fetus.2) From an analysis of time lag between the onset of the EM period and the first micturition thereafter, 72% of all micturitions occurred within 8 min, after the onset of the EM perod in the fetuses at 37 weeks on-wards. This indicates a temporal relationship between the onset of the EM period and the first micturition thereafter.3) Two statistically critical points for the duration of the EM period were noted at 29-30 and 37-38 weeks' gestation, whereas for the duration of the NEM period, 2 critical points were again found at 31-32 and 37-38 weeks' gestation. These findings su … More ggest that two separate mechanisms exist, one for maintaining the duration of the EM period and another for maintaining the duration of the NEM period. Both switching and maintaining mechanisms respinsible for ultradian thythm of EM and NEM periods have matured at term.4) We examined whether fetal behavioral patterns could be usued to localize sites of brain damage antenatally. Decreased fetal mobement, persistent non-reactive fetal heart rate (FHR) pattern, and/or central nervous system malformation were usued as indicators of possible neuro-logical impairment. 10 fetuses with the above mentioned criteria underwent further ultrasound examination ob-seuving movement of the extremities, breathing, eye and mouth and active/quiet FHR patterns. 8 of these ten fetuses were found, on postnatal examination, to have a brain impairment. the fetuses having potential inutero brain impairment were grouped into four : cases with (1) lesion sites at, or caudal to, the pons-medulla which were specifically identified by fetal behavior, (2) diffuse lesions in the brain which, although resulting in abnormal behavior, could not be localized by this behabior, (3) lesions localized in the cerebral hemi-sphere (s) but no abnormal behavior, and (4) temporally abnormal behavior in utero, finally changing over to a normal pattern with no neonatal neurologic abnormality. A screening system for the antenatal assessment of brain impairment is thus proposed. Less