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，健康和发育结果也各不相同。结果的这些变化导致了新生儿重症监护室环境，特别是光线可能影响结果的猜测。最近，循环光已经显示出比接近黑暗的短期益处，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长期持续。一些证据表明，在孕龄28周时，视觉感觉系统能够处理光刺激，因为大脑具有完整的神经元，迁移和分化开始，视交叉上核受视网膜支配并对光有反应。 这项拟议的研究评估了在整个住院期间早期与晚期循环光照对妊娠< 28周出生的婴儿的短期和长期健康和发育结果的时间和影响。采用纵向随机实验设计，将140名婴儿分配到：（1）早期循环光照（孕后28周[PCA]）或（2）晚期循环光照（36周PCA）。在整个住院期间将对婴儿进行随访，以评价体重增加、住院天数、睡眠-觉醒状态发育、早产儿视网膜病变和听觉敏锐度的短期结局。婴儿出院后将随访至24个月矫正年龄，以评价体重增加、睡眠模式、视力、发育（认知、运动、语言）和神经学结局。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连续变量和分类变量的混合数据。接受早期循环光的早产儿预计会有更好的结果，因为他们将在可以使用时接受循环光。虽然全国各地的大多数NICU都以某种方式修改了光环境，但并不存在环境光护理的国家标准，因此确定何时循环光或接近黑暗是最合适的非常重要。

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.