PRETERM SKIN CONTACT EFFECTS ON ELECTROPHYSIOLOGIC SLEEP

通过行为状态指数衡量，皮肤对皮肤接触(SSC)可以增加安静睡眠的频率和持续时间。然而，行为状态测量受到观察者偏差和记录误差的影响--使用脑电(EEG)、眼电(EOG)、肌电(EMG)和呼吸波形指示器对睡眠进行电生理记录时不存在的限制。然而，关于SSC过程中睡眠的电生理学研究尚未见报道。本研究的目的是确定SSC对电生理决定的睡眠的影响，并测试与潜伏期以及治疗组和对照组相比，SSC期间安静睡眠的显着增加。将获得60个医学稳定的32周加4天的完整数据集，并通过最小化技术将受试者随机分配到SSC或对照组，进行为期一天的测试。所有婴儿将在蒙面保育箱中接受3小时的监测(测试前)，当他们以嵌套俯卧姿势躺着时，然后在测试期间进行3小时的监测。在测试期间，对照组婴儿仍在保育箱中，条件相同；SSC婴儿将以胸对胸、直立姿势、母亲乳房之间的皮肤对皮肤的方式被抱着，母亲斜倚在NICU保育箱一侧的固定椅子上。使用配有12型神经数据采集系统(Astromed-Grass)的Grass K2GR测谎仪，在速度为30 mm/S的热敏纸上实时记录EEG、EOG、EMG和呼吸波形。当行为观察发生时，将在跟踪中记录它们。描记将由一位多导EEG/EOG/EMG/呼吸波形记录方面的专家神经科医生读取。神经科医生的记录仪将对组和周期视而不见，即使所有测试从上午9点开始。在马里兰州巴尔的摩马里兰大学医学中心的新生儿重症监护病房喂养。脑电由Grass Gold在O2和C4两个点上用7 mm电极采集，肌电由两个金属下电极采集，EOG由每只眼的外眼角电极采集，呼吸波形由Grass提供的胸廓漂移带采集。每分钟都会记录光线、噪音和湿度。所有电极将在检测前至少30分钟连接到婴儿身上，以便进行校准和预热。结果测量是安静睡眠、活动睡眠、不确定睡眠和总睡眠时间的时数。还将计算增量刷波和theta波插曲的数量。几乎所有的分析都将基于对每个对象的重复观察；将使用为纵向数据制定的各种类型的回归分析(线性、逻辑或泊松)。在重复测量分析之前，将数据划分为15分钟的数据段。

Skin-to-skin contact (SSC) has been shown to increase quiet sleep frequency and duration as measured by behavioral state indices. Yet, behavioral state measurements are subject to observer bias and recording error-limitations not present with electrophysiologic recording of sleep using electroencephalographic (EEG), electrooculographic (EOG), electromyographic (EMG), and respiratory waveform indicators. Yet, no electrophysiologic studies of sleep during SSC have been reported. The purpose of this study is to determine the effect of SSC on electrophysiologic- determined sleep and to test for a significant increase in Quiet Sleep during SSC as compared to incubator periods and between the treatment and control groups. Complete data sets from 60 medically stable 32 weeks plus 4 days conceptional age will be obtained and subjects will be randomly assigned by minimization technique to SSC or control group for one day of testing. All infants will be monitored in hooded incubators for 3 hours (pretest) as they lay in a nested prone position, followed by three hours of monitoring during the test period. In the test period control infants remain in the incubator in the same conditions; SSC infants will be held in chest-to-chest, upright position, skin-to-skin between maternal breasts as mother reclines in a stationary chair at the side of the incubator in the NICU. EEG, EOG, EMG, and respiratory waveform will be recorded in real time on thermal paper running at 30 mm/s using the Grass K2GR polygraph outfitted with Model 12 Neurodata Acquisition System (Astromed-Grass). Behavioral observations will be noted on the tracing as they occur. Tracings will be read by one neurologist who is a specialist in polygraphic EEG/EOG/EMG/Respiratory Waveform recording. The neurologist recorder will be blind to group and period, even though all testing commences with the 9 a.m. feeding in the neonatal intensive care unit of University of Maryland Medical Center, Baltimore, MD. EEG is obtained by Grass gold 7 mm electrodes over O2 and C4 points, EMG by two submental electrodes, EOG by electrodes at the outer canthus of each eye, Respiratory waveform by thoracic excursion belt provided by Grass. Light, noise and humidity will be recorded each minute. All electrodes will be attached to infants at least 30 minutes prior to testing to allow for calibration and warm-up. Outcome measures are number of epochs of Quiet Sleep, Active Sleep, Indeterminate Sleep, and Total Sleep Time. Number of delta brush and theta wave episodes will be calculated too. Nearly all analyses will be based on repeated observations on each subject; various types of regression analysis (linear, logistic, or Poisson as appropriate) formulated for longitudinal data will be used. Partitioning of data into fifteen minute segments will be performed prior to repeated measures analysis.