Sleep-related behavior and cortical activity in premature human infants as predictors of developmental outcomes.

项目总结 睡眠渗透到我们早期的存在中：一个典型的人类新生儿每天平均睡16个小时 在活跃(快速眼动)睡眠和安静睡眠之间。新生儿活跃睡眠的比例相对较高 为几十年前的假设奠定了基础，即积极睡眠对婴儿大脑发育很重要。在……里面 考虑到这一假设，重要的是要记住，活跃的睡眠是一种复杂的状态，由 在发育过程中出现并结合的各种行为和生理成分。因此，它可能 这些成分中的一个或多个在促进大脑发育方面发挥着巨大的作用。这样的一个 候选成分是包括四肢、面部和眼睛抽动的阶段性活动。在过去的时间里 15年来，对幼年大鼠的研究表明，抽搐肢体的感觉反馈会触发离散的和 整个感觉运动系统都有丰富的活动，从脊髓到脑干， 小脑、丘脑、感觉运动皮质和海马体。近年来，在盖茨夫妇的资助下， 基金会和NICHD的R21，在前七年将研究扩展到足月人类婴儿 出生后的几个月。使用行为测量和高密度脑电(EEG)记录，这 研究揭示了迄今为止未知的婴儿睡眠和睡眠的时空组织特征 并引入了新的发展里程碑和假设。在这里，我们建议延长这些 早产儿的努力有两个原因：早产儿表现出的活跃睡眠比例甚至高于 新生儿足月出生，他们患运动技能缺陷、脑瘫、自闭症和 其他神经发育障碍。因此，我们将确定抽搐是否可以提高我们的理解 了解非典型发育轨迹的起源和时间进程，并指导今后的干预措施。非常早产 人类婴儿(绝经后32周)和轻度早产儿(绝经后32-36周) 爱荷华大学斯特德家庭儿童医院的新生儿重症监护病房(NICU)将 被招募参加一项横跨出院前(第一阶段)和出院后(第二阶段)的纵向研究 从NICU来的。在第一阶段，每两周记录一次睡眠行为和脑电活动，以及 呼吸频率。在第二阶段，相同的早产儿和足月年龄匹配的对照组的睡眠 行为、脑电活动和呼吸频率将在一周至六个月期间记录三次 修正后的年龄。神经行为和运动技能评估将在1个月和6个月大时进行。 临床随访评估将在两岁时进行。因为这项研究是纵向的， 相同婴儿的行为和生理睡眠数据将在第一阶段和第二阶段以及相关阶段进行比较 发展成果。最终，这个项目将提供一个前所未有的机会来了解 睡眠和与睡眠相关的行为如何促进早期生活中典型和非典型的发育。

PROJECT SUMMARY Sleep permeates our early existence: A typical human newborn sleeps 16 hours each day, evenly divided between active (REM) sleep and quiet sleep. The relatively high proportion of active sleep in newborns is the foundation for the decades-old hypothesis that active sleep is important for infant brain development. In considering this hypothesis, it is important to remember that active sleep is a complex state composed of a variety of behavioral and physiological components that emerge and coalesce over development. Thus, it may be that one or more of these components play outsized roles in promoting brain development. One such candidate component is the phasic activity that comprises twitches of the limbs, face, and eyes. Over the past 15 years, research in infant rats has revealed that sensory feedback from twitching limbs triggers discrete and abundant activity throughout the sensorimotor system, cascading from the spinal cord to the brainstem, cerebellum, thalamus, sensorimotor cortex, and hippocampus. In recent years, with funding from the Gates Foundation and an R21 from NICHD, investigations were extended to full-term human infants over the first seven postnatal months. Using behavioral measures and high-density electroencephalographic (EEG) recordings, this research revealed heretofore unknown features about the spatiotemporal organization of infant sleep and twitching and introduced new developmental milestones and hypotheses. Here, we propose to extend these efforts to preterm infants for two reasons: Preterm infants exhibit an even higher proportion of active sleep than newborn full-term infants, and they are at increased risk for deficits in motor skill, cerebral palsy, autism, and other neurodevelopmental disorders. Thus, we will determine whether twitching can enhance our understanding of the origins and time course of atypical developmental trajectories and guide future interventions. Very preterm human infants (<32 weeks postmenstrual age) and mildly preterm infants (32-36 weeks postmenstrual age) in the neonatal intensive care unit (NICU) in the Stead Family Children’s Hospital at the University of Iowa will be recruited to participate in a longitudinal study spanning the period before (Phase I) and after (Phase II) discharge from the NICU. Every two weeks during Phase I, sleep behavior will be recorded along with EEG activity, and respiratory rate. During Phase II, in the same preterm infants as well as full-term age-matched controls, sleep behavior, EEG activity, and respiratory rate will be recorded three times between one week and six months corrected age. Neurobehavioral and motor skill assessments will be performed at one and six months of age and clinical follow-up assessments will be performed at two years of age. Because this study is longitudinal, behavioral and physiological sleep data will be compared in the same infants across Phases I and II and related to developmental outcomes. Ultimately, this project will provide an unprecedented opportunity to understand how sleep and sleep-related behavior contribute to typical and atypical development in early life.