Ontogenesis of the Rapid Eye Movement/Non-Rapid Eye Movement Sleep and Waking States in the Human Fetus

1)胎儿瞳孔直径有统计学差异，散瞳组为9.7%，缩瞳组为90.3%（1.7mm）。在眼动（EM）期间散瞳的百分比（14.3%）显著高于无眼动期（NEM）（2.3%），表明人类足月胎儿瞳孔扩张与眼球运动周期之间存在密切关系。2）从EM期开始与其后第一次排尿之间的时间滞后分析，72%的排尿发生在37周EM期开始后8 min内。这表明EM期的开始与其后的首次排尿之间存在时间关系。3）EM期持续时间的两个统计学临界点在妊娠29-30周和37-38周，而NEM期持续时间的两个统计学临界点在妊娠31-32周和37-38周。这些发现表明， ...更多信息 考虑到存在两个独立的机制，一个用于维持EM时段的持续时间，另一个用于维持NEM时段的持续时间。对EM和NEM期的超昼夜节律负责的转换和维持机制在足月时已经成熟。4）我们研究了胎儿行为模式是否可以用于产前脑损伤的定位。胎儿活动减少、持续无反应性胎心率（FHR）模式和/或中枢神经系统畸形被用作可能的神经系统损害的指标。对10例符合上述标准的胎儿作进一步超声检查，观察四肢运动、呼吸、眼、口及活动/安静胎心率模式。出生后检查发现这10只胎仔中有8只存在脑损伤。将具有潜在宫内脑损伤的胎儿分为四组：例（1）病变部位在脑桥-延髓或脑桥-延髓尾侧，可通过胎儿行为特异性识别，（2）脑内弥漫性病变，虽然可导致异常行为，但不能通过该行为定位，（3）病变位于大脑半球，但无异常行为，（4）宫内暂时性行为异常，最终转变为正常模式，无新生儿神经系统异常。因此，提出了一种用于产前评估脑损伤的筛查系统。少

1) Fetal pupillary deameters were statistically differ-entiated into two groups : 9.7% for dilated pupil and 90.3% for constricted pupil (1.7mm). The percentage of dilated pupil during the eye movement (EM) period (14.3%) was significantly greater than that during no eye movement (NEM) period (2.3%), thereby indicating a close relation between pupillary dilatation and eye movement periods in the human term fetus.2) From an analysis of time lag between the onset of the EM period and the first micturition thereafter, 72% of all micturitions occurred within 8 min, after the onset of the EM perod in the fetuses at 37 weeks on-wards. This indicates a temporal relationship between the onset of the EM period and the first micturition thereafter.3) Two statistically critical points for the duration of the EM period were noted at 29-30 and 37-38 weeks' gestation, whereas for the duration of the NEM period, 2 critical points were again found at 31-32 and 37-38 weeks' gestation. These findings su … More ggest that two separate mechanisms exist, one for maintaining the duration of the EM period and another for maintaining the duration of the NEM period. Both switching and maintaining mechanisms respinsible for ultradian thythm of EM and NEM periods have matured at term.4) We examined whether fetal behavioral patterns could be usued to localize sites of brain damage antenatally. Decreased fetal mobement, persistent non-reactive fetal heart rate (FHR) pattern, and/or central nervous system malformation were usued as indicators of possible neuro-logical impairment. 10 fetuses with the above mentioned criteria underwent further ultrasound examination ob-seuving movement of the extremities, breathing, eye and mouth and active/quiet FHR patterns. 8 of these ten fetuses were found, on postnatal examination, to have a brain impairment. the fetuses having potential inutero brain impairment were grouped into four : cases with (1) lesion sites at, or caudal to, the pons-medulla which were specifically identified by fetal behavior, (2) diffuse lesions in the brain which, although resulting in abnormal behavior, could not be localized by this behabior, (3) lesions localized in the cerebral hemi-sphere (s) but no abnormal behavior, and (4) temporally abnormal behavior in utero, finally changing over to a normal pattern with no neonatal neurologic abnormality. A screening system for the antenatal assessment of brain impairment is thus proposed. Less