MODULATION OF CIRCADIAN RHYTHMICITY IN PRETERM INFANTS

描述（改编自申请人的摘要）： 儿科和新生儿的设计一样， 重症监护室及其对早产儿发育的影响 婴儿。 尽管卫生保健提供者已经产生了许多关于 环境刺激的类型和模式， 发展，没有科学共识是什么构成了一个 “合适”的环境。 本提案的目标是描述 发育中早产儿的昼夜节律系统，并通过 环境干预如何使新生儿重症监护室（NICU） 环境影响长期的生理、行为和临床结果。 为了实现这些目标，研究人员将研究：（1） 来自时间生物学的NICU和家庭环境照明和声级 透视;以及（2）婴儿昼夜节律系统的输出：心率， 体温和睡眠-觉醒节律。 他们证明， 生物钟的主要传入途径（视网膜下丘脑）是 最早出现在孕后29周，全国范围内的NICU 照明随时间变化很大，并且在 床边 因为光是生物钟最重要的时间表 系统，早产儿发育的昼夜节律系统可能会受到影响， 照明。 发展基准已在其 实验室，描述了个体发育的昼夜节律系统，在这两个 早产儿和足月儿及其新开发的视频睡眠图 将允许定量测量新生儿睡眠和昼夜节律 在医院和家里。 这些研究的重点是使用 评估环境影响的发展基准 干预，即24小时光的节律模式，在NICU中， 结果的定量测量。 光的刺激有很强的影响力 对成人的睡眠和/或生物节律性的影响;然而，很少有数据 以评估其对住院早产儿的影响。 他们 假设光暗循环将促进睡眠巩固， 早产儿昼夜节律的发展，并缓解 从幼儿园到家庭的过渡， 光周期刺激将在家中持续。 他们希望 干预组的早产儿会长得更快， 在呼吸机上，更早开始乳头，神经学上会更成熟， 36周龄后受孕年龄，并将提前出院。 1个月和3个月 年龄，这些婴儿将显示更成熟的昼夜节律，显示更好的 夜间沉降，神经学和临床上将更加成熟 比对照组。

DESCRIPTION (Adapted from the applicant's abstract): Few areas in Pediatrics have remained as controversial as the design of Neonatal Intensive Care Nurseries and their impact on development of premature infants. Although health care providers have generated many ideas about the types and patterns of environmental stimulation that may optimize development, there is no scientific consensus on what constitutes an "appropriate" environment. The goal of this proposal is to characterize the circadian system of the developing preterm infant and to explore by way of environmental intervention how the Neonatal Intensive Care Unit (NICU) environment influences long-term physiology, behavior and clinical outcomes. In order to achieve these goals the investigators will examine: (1) the NICU and home ambient lighting and sound level from a chronobiological perspective; and (2) the output of the infant circadian system: heart rate, body temperature and sleep-wake rhythms. They have demonstrated that the major afferent pathway (retinohypothalmic) to the biological clock is present as early as 29 weeks postconceptional age, and that nationwide NICU illumination varies considerably and randomly over time and between bedsides. Since light is the most important zeitgeber of circadian timing system, the preterm infant developing circadian system may be affected by the illumination. Developmental benchmarks have been established in their laboratory that describe the ontogeny of the circadian system in both premature and full term infants, and their newly developed video somnography will allow quantitative measurement of neonatal sleep and circadian rhythms in the hospital and home. The focus of these studies is to use developmental benchmarks to evaluate the effect of environmental intervention, namely 24 hr rhythmic patterns of light, in the NICU on quantitative measures of outcome. Light stimuli have a powerful influence on sleep and/or biological rhythmicity in adults; however, little data are available to assess their effects on hospitalized preterm infants. They hypothesize that light-dark cycling will facilitate sleep consolidation and the development of circadian rhythmicity in preterm infants, and ease the transition from the nursery to the home and that the long-term effects of the photoperiodic stimulation will persist at home. They expect that the preterm infants in the intervention group will grow faster, have less time on ventilator, start nippling earlier, will be neurologically more mature at 36 wk postconceptual age and will be discharged sooner. At 1 and 3 months of age, these infants will show more mature circadian rhythms, show better nighttime settling and will be neurologically and clinically more mature than controls.