MODULATION OF CIRCADIAN RHYTHMICITY IN PRETERM INFANTS

描述(改编自申请人的摘要)：以下几个领域 儿科和新生儿的设计一样存在争议 重症监护室及其对早产儿发育的影响 婴儿。尽管医疗保健提供者产生了许多关于 可优化的环境刺激的类型和模式 发展，但对于什么构成一个 “适当”的环境。这项提案的目标是将 早产儿发育期昼夜节律的研究 环境干预如何在新生儿重症监护病房(NICU) 环境会影响长期的生理、行为和临床结果。 为了实现这些目标，调查人员将审查：(1) NICU和家庭环境照明和声级来自时间生物学 透视；(2)婴儿昼夜节律系统的输出：心率， 体温和睡眠-觉醒节律。他们已经证明了 生物钟的主要传入通路(视黄醇下丘脑)是 最早出现在受孕后29周，全国范围内的NICU 照度随时间和时间的不同而变化很大且随机 床边。因为光是昼夜节律最重要的时间因素 系统，早产儿发育的昼夜节律系统可能受到 照明。发展基准已经在他们的 描述昼夜节律系统个体发育的实验室 早产儿和足月儿及其新开发的视频睡眠图 将允许对新生儿睡眠和昼夜节律进行定量测量 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小时有节奏的光模式，在NICU 对结果的量化衡量。光刺激有很强的影响力 关于成年人的睡眠和/或生物节律性；然而，很少有数据 可用于评估其对住院早产儿的影响。他们 假设明暗循环将促进睡眠巩固和 早产儿昼夜节律性的发展及缓解 从托儿所到家庭的过渡以及 光周期刺激将在国内持续存在。他们期待着 干预组早产儿生长快，时间少 在呼吸机上，乳头开始得更早，在 产后36周，将很快出院。1个月和3个月 随着年龄的增长，这些婴儿会表现出更成熟的昼夜节律，表现得更好 夜间稳定下来，在神经学和临床上将更加成熟 而不是控制。

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.