Recent experimental data suggest a strong role for sleep in brain development. As sleep is the predominant behavioral state in the term and especially the preterm newborn, these data underline the importance of respecting sleep duration and organization within the different sleep states. Polysomnography is the preferred technique used for identification of sleep state; however, behavioral observations-under the condition that the observer is well trained-may prove as efficient. Newborns hospitalized in the neonatal intensive care unit are exposed to many stimuli and care activities that disrupt their sleep organization and may have irreversible effects on their brain development. In order to improve the long-term neurobehavioral outcome of these high-risk subjects, a consistent care approach is proposed. Application of the Neonatal Individualized Developmental Care and Assessment Program decreases environmental stressful events and promotes harmonious well-being behaviors, based on an individual approach. This strategy has encouraging results, showing an increase in sleep duration under Neonatal Individualized Developmental Care and Assessment Program conditions, but further studies are needed to assess its long-term neurobehavioral impact.
"The most immature neonates will spend as long as three to four months in the neonatal intensive care unit and are subjected to environmental effects for a longer period of time. Developmentally sensitive carepaths for nurses and physicians have been developed to improve ongoing care for neonates as assessed by sleep, growth and age at discharge (Bertelle et al 2005) (Bertelle et al. 2007). "
[Show abstract][Hide abstract] ABSTRACT: Skin-to-skin contact (SSC) promotes physiological stability and interaction between parents and infants. Analyses of EEG-sleep studies can compare functional brain maturation between SSC and non-SSC cohorts.
Sixteen EEG-sleep studies were performed on eight preterm infants who received 8 weeks of SSC, and compared with two non-SSC cohorts at term (N=126), a preterm group corrected to term age and a full-term group. Seven linear and two complexity measures were compared (Mann-Whitney U test comparisons p<.05).
Fewer REMs, more quiet sleep, increased respiratory regularity, longer cycles, and less spectral beta were noted for SSC preterm infants compared with both control cohorts. Fewer REMs, greater arousals and more quiet sleep were noted for SSC infants compared with the non-SSC preterms at term. Three right hemispheric regions had greater complexity in the SSC group. Discriminant analysis showed that the SSC cohort was closer to the non-SSC full-term cohort.
Skin-to-skin contact accelerates brain maturation in healthy preterm infants compared with two groups without SSC.
Combined use of linear and complexity analysis strategies offer complementary information regarding altered neuronal functions after developmental care interventions. Such analyses may be helpful to assess other neuroprotection strategies.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 09/2009; 120(10):1812-8. DOI:10.1016/j.clinph.2009.08.004 · 3.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine prevalence rates of symptoms of several sleep disorders in young children, and the relationship between symptoms of pediatric sleep disorders and other childhood problems. Two-hundred-seventy-six children aged 2 to 5 years were studied through examination of a pre-existing database. Children rated as high risk for having a sleep disorder displayed significantly more aggressive behavior and attention problems, as compared to children whose sleep was rated in the normal range. However, no relationship was found between symptoms of sleep disorders and body mass index, asthma, or allergies. In addition, no relationship was found between symptoms of sleep disorders and social skills. Twenty-six percent of children in this sample were at high risk for having at least one type of sleep disorder. Results are discussed with regard to implications for prevention and early identification of students who are at-risk for developing sleep disorders, as well as direct interventions for those students who have a diagnosed sleep disorder.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the neurodevelopmental outcome of preterm infants with a grade III or IV hemorrhage and to assess the effect of routine low-threshold therapy of post-hemorrhagic ventricular dilatation (PHVD) on neurodevelopmental outcome.
Of the 214 preterm infants (< or = 34 weeks gestational age), 94 (44%) had a grade III intraventricular hemorrhage (IVH), and 120 (56%) had a grade IV hemorrhage. We evaluated the natural evolution of IVH, the need for intervention for PHVD, and neurodevelopmental outcome at 24 months corrected age.
PHVD developed significantly more often in the surviving infants with a grade III hemorrhage (53/68, 78%) than in infants with a grade IV hemorrhage (40/76, 53%; P = .002). Intervention for PHVD was required significantly more often in the grade III group, than in the grade IV group (P < .001). In the grade III group, cerebral palsy developed in 5 of the 68 surviving infants (7.4%), compared with 37 of the 76 infants (48.7%) with a grade IV hemorrhage (P < .001). The mean developmental quotient (DQ) in the grade III group was 99, and in the grade IV-group it was 95 at 24 months corrected age.
Short-term neurodevelopmental outcome of preterm infants with grade III or IV hemorrhage was better than reported earlier. Requiring intervention for PHVD only had a negative effect on DQ in infants with a grade IV hemorrhage. Infants with cerebral palsy had significantly lower DQs, irrespective of the severity of IVH.
The Journal of pediatrics 06/2008; 152(5). DOI:10.1016/j.jpeds.2007.10.005 · 3.79 Impact Factor
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