Impact of the ICU acoustic environment on neonatal sleep

ICU声环境对新生儿睡眠的影响

• 批准号: 8867685
• 负责人: Renee A. Shellhaas
• 金额: $ 22.76万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8867685
• 关键词: Acoustics; Address; Admission activity; Age; Biological Markers; Brain; Brain Injuries; Brain hemorrhage; Caring; Child; Complex; Data; Development; Entropy; Environment; Environmental Risk Factor; Exhibits; Exposure to; Future; Generations; Gestational Age; Goals; Health; Impact evaluation; Infant; Knowledge; Language; Language Development; Length; Measures; Mentored Patient-Oriented Research Career Development Award; Methods; Mission; Modeling; Monitor; Morbidity - disease rate; Mothers; Neonatal; Neonatal Intensive Care Units; Nervous System Physiology; Neurodevelopmental Disability; Neurologic; Neurological status; Newborn Infant; Noise; Outcome; Patients; Pattern; Physiology; Polysomnography; Premature Infant; Probability; Research; Research Design; Research Personnel; Respiration; Risk; Sensory; Severity of illness; Sleep; Sleep Fragmentations; Sleep Stages; Sleep Wake Cycle; Speech; Stage I Sleep; Staging; Stimulus; Techniques; Testing; Therapeutic; United States National Institutes of Health; Wakefulness; Work; clinical care; design; disability; high risk; high risk infant; improved; in utero; infancy; innovation; method development; multidisciplinary; neonate; neurobehavioral; neurodevelopment; novel; postnatal; public health relevance; sleep regulation; sound; therapy design; treatment as usual

 DESCRIPTION (provided by applicant): More than 400,000 newborns delivered each year in the U.S. require admission to neonatal intensive care units (NICUs). Many of these infants later develop substantial neurologic morbidity. Our long-term hypothesis is that the NICU sensory environment, which differs dramatically from the in utero milieu, disrupts the stimulus- sensitive plasticity of the immature brain and contributes to abnormal developmental outcome, at least in some vulnerable infants. Healthy newborns generate sleep, a complex and highly regulated neurologic function, for two-thirds of each day. Emerging evidence suggests that disturbed sleep physiology during late infancy contributes to subsequent adverse neurobehavioral outcomes. Sleep is rarely analyzed in sick neonates, in part because of a key unsolved challenge: a practical, validated, and quantitative approach to monitoring neonatal sleep cycling has not been established. Innovative preliminary work by the investigators now suggests that several quantitative sleep measures - sleep/wake bout lengths, sleep fragmentation (entropy), and stage transition probabilities - may predict neurologic status. Yet, the optimal environment to promote ideal neonatal sleep is unknown. Compelling recent data highlight the complexities inherent in efforts to optimize the NICU environment. Preterm infants protected from extrinsic sound, to minimize sleep disruption, showed poor language development. Conversely, increased language exposure in the NICU led to better long-term language development. Therefore, simple provision of a quiet NICU environment may not be an ideal therapeutic approach. In this setting, the research now proposed is guided by the following Global Hypothesis: For neonates, normal quality and quantity of sleep contribute to optimal neurodevelopment, but sleep is disrupted in the NICU by potentially modifiable environmental noise. Aim 1: Characterize the above novel quantitative sleep measures as a function of gestational age and postnatal age, adjusted for illness severity, among 50 late-preterm and term NICU patients. Aim 2: Determine the sensitivity of these quantitative sleep measures to non-language noise, conversation, and periods of silence, quantified by automated language environment analysis (LENA) testing during polysomnography. Aim 3: Assess the effect of enriched exposure to mother's speech, as opposed to non-language noise, on neonatal sleep, as measured by sleep/wake bout lengths, entropy, and stage transition probabilities. Application of formal PSG in the NICU, with innovative analytic techniques to assess sleep stage distribution and sleep fragmentation, will provide novel, objective measures of neonatal brain functional integrity. The proposed study will be the first to assess the influence of the NICU acoustic environment on quantitative PSG data. Results will inform the subsequent design of interventions to optimize the NICU acoustic environment, ameliorate sleep regulation, and improve neurodevelopmental outcomes.

 描述（由申请人提供）：美国每年有超过40万名新生儿需要进入新生儿重症监护室（NICU）。这些婴儿中的许多人后来发展为严重的神经系统疾病。我们的长期假设是，NICU感觉环境与子宫内环境显著不同，破坏了未成熟大脑的刺激敏感可塑性，并导致异常发育结果，至少在一些脆弱的婴儿中是如此。健康的新生儿每天有三分之二的时间产生睡眠，这是一种复杂且高度调节的神经功能。新出现的证据表明，婴儿后期睡眠生理紊乱导致随后的不良神经行为结果。睡眠很少在生病的新生儿进行分析，部分原因是一个关键的未解决的挑战：一个实用的，有效的，和定量的方法来监测新生儿的睡眠周期尚未建立。研究人员的创新性初步工作现在表明，几种定量睡眠测量-睡眠/觉醒时间，睡眠片段（熵）和阶段转换概率-可以预测神经系统状态。然而，促进理想新生儿睡眠的最佳环境尚不清楚。令人信服的最新数据突出了优化NICU环境的努力所固有的复杂性。早产儿不受外界声音的影响，以尽量减少睡眠中断，表现出语言发育不良。相反，在NICU中增加语言接触会导致更好的长期语言发展。因此，简单地提供安静的NICU环境可能不是理想的治疗方法。在这种情况下，现在提出的研究是由以下全球假设指导的：对于新生儿，正常的睡眠质量和数量有助于最佳的神经发育，但睡眠在NICU中被潜在的可修改的环境噪音所干扰。目标1：在50名晚期早产和足月新生儿重症监护病房患者中，将上述新的定量睡眠测量表征为孕龄和出生后年龄的函数，并根据疾病严重程度进行调整。目标二：确定这些定量睡眠测量对非语言噪音、谈话和沉默期的敏感性，这些敏感性通过多导睡眠图期间的自动语言环境分析（LENA）测试进行量化。目标3：评估丰富暴露于母亲的讲话，而不是非语言噪音，对新生儿睡眠的影响，如睡眠/清醒回合长度，熵和阶段转换概率。在新生儿重症监护室应用正式的多导睡眠图，采用创新的分析技术来评估睡眠阶段分布和睡眠片段，将提供新的，客观的新生儿脑功能完整性的措施。拟议的研究将是第一个评估NICU声学环境对定量PSG数据的影响。研究结果将为后续的干预设计提供信息，以优化NICU的声学环境，改善睡眠调节，改善神经发育结果。