Preterm Infants: Light Effects on Health and Development

描述(由申请人提供)：即使在最健康的早产儿中，健康和发育结果也不同。这些结果的差异导致了人们的猜测，即新生儿重症监护病房的环境，特别是光线，可能会影响结果。最近，循环光在接近黑暗的情况下显示出了短期的益处，但尚不清楚应该在什么胎龄开始循环光，以及这些益处是否会长期存在。一些证据表明，在28周胎龄时，视觉感觉系统能够处理光刺激，因为大脑有完整的神经元补充，迁移和分化开始，视交叉上核受到视网膜的支配并对光做出反应。这项拟议的研究评估了住院期间早期和晚期周期光照对妊娠28周出生的婴儿的短期和长期健康和发育结果的影响。利用纵向随机实验设计，140名婴儿将被分配到：(1)早期周期光(怀孕后28周[PCA])或(2)晚期周期光(36周PCA)。将在整个住院期间对婴儿进行跟踪，以评估体重增加、住院天数、睡眠觉醒状态发展、早产儿视网膜病变和听力的短期结果。婴儿出院后将接受跟踪，直到矫正年龄24个月，以评估体重增加、睡眠模式、视力、发育(认知、运动、语言)和神经结果。数据是连续变量和分类变量的混合，将使用混合一般线性模型、广义估计方程、多重方差分析和卡方分析进行分析。早期接受循环光治疗的早产儿预计会有更好的结果，因为他们将在可以利用的时候接受循环光。虽然全国各地的大多数NICU都以某种方式修改了光环境，但并不存在关爱环境光的国家标准，因此确定何时循环照明或接近黑暗是最合适的，这一点很重要。

DESCRIPTION (provided by applicant): Health and developmental outcomes vary even among the healthiest preterm infants. These variations in outcome have led to speculation that the neonatal intensive care unit environment, and light in particular, may impact outcomes. Recently, cycled light has shown short-term benefits over near darkness, but it is unclear at what gestational age cycled light should be initiated and whether these benefits continue long term. Some evidence suggests that at 28-weeks gestational age the visual sensory system is capable of handling light stimulation since the brain has a full complement of neurons, migration and differentiation is beginning, and the suprachiasmatic nuclei is innervated by the retina and responsive to light. The proposed study evaluates the timing and effects of early versus late cycled light throughout hospitalization on short-and long-term health and developmental outcomes in infants born at < 28 weeks gestation. Utilizing a longitudinal randomized experimental design, 140 infants will be assigned to either: (1) early cycled light (28 weeks post-conceptional age [PCA]) or (2) late cycled light (36 weeks PCA). Infants will be followed throughout hospitalization to evaluate the short-term outcomes of weight gain, number hospital days, sleep-wake state development, retinopathy of prematurity, and auditory acuity. Infants will be followed after discharge until 24 months corrected age to evaluate weight gain, sleep patterns, visual acuity, development (cognitive, motor, language) and neurological outcomes. Data, a mixture of continuous and categorical variables, will be analyzed using mixed general linear models, generalized estimating equations, multiple analysis of variance, and chi-square. Preterm infants receiving early cycled-light are expected to have better outcomes because they will receive cycled light when it can be utilized. While most NICUs across the country modify the light environment in some fashion, a national standard of care for environmental light does not exist, therefore it is important to determine when cycled light or near darkness is most appropriate.