Rapid eye movement (REM) in premature neonates and developmental outcome at 6 months

Department of Psychology and the Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.
Infant behavior & development (Impact Factor: 1.34). 12/2008; 32(1):27-32. DOI: 10.1016/j.infbeh.2008.09.001
Source: PubMed


Different aspects of early sleep organization have been associated with subsequent development in premature infants. The aim of the present study was to assess the relations between rapid eye movement (REM) activity in premature neonates and infants' developmental outcomes at 6 months. Participants were 81 premature infants (47 males). Sleep-wake states and REM were observed across 4 consecutive evening hours (7-11 PM) in 10-s frames when infants were between 32 and 36 weeks post-menstrual age. Developmental outcome was assessed at 6 months with the mental development index (MDI) of the Bayley II. Infants with low-REM activity spent more time in less growth-promoting states, including crying and unfocused alert states in the neonatal period and had lower MDI scores at 6 months corrected age compared to infants with high-REM. Differences between the high- and low-REM groups were independent of neonatal medical risk. Low-REM activity may serve as an indicator of developmental risk among premature neonates.

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    • "Whether infants in the NICU have enough sleep for growth and neurosensory development is an important issue for clinicians to explore. Enhancing preterm infants' neurosensory development requires understanding the social-contextual and environmental factors that influence their sleep and using strategies to preserve infants' sleep in the NICU (Arditi-Babchuk et al., 2009; Lopez et al., 2008). "
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    ABSTRACT: In this prospective, descriptive study, we used a repeated-measures design to explore the 24-hour effects of caregiving and positioning on preterm infants' states and the factors associated with state changes. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days in the neonatal intensive care unit to record six states: quiet sleep (QS), active sleep, transition, active awake, quiet awake, and fussy or crying. The occurrences of QS increased when infants received no caregiving, social interaction, non-nutritive sucking (NNS), and were laterally positioned. However, QS significantly decreased and fussy or crying state increased when infants received routine and intrusive caregiving. These results suggest that caregiving, NNS, and positioning should be appropriately provided to facilitate infants' sleep, and reduce fussiness or crying.
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    • "In a similar investigation, Gertner et al. [33] reported that a lower percentage of time spent in active sleep (AS) in premature infants was associated with lower Bayley Mental Development Index (MDI) scores at 6 months of age. Additionally less time spent in the REM sleep state has been associated with lower MDI scores at 6 months in preterm infants [34]. Similarly, in term infants, fewer arousals and less REMs per minute were predictive of lower MDI scores at 12 months of age [35]. "
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    ABSTRACT: Docosahexaenoic acid (DHA; 22:6n-3) is highly important during pregnancy for optimal development and functioning of fetal neural tissue. Infant ability to organize sleep and wake states following parturition is highly associated with later developmental outcomes. The impact of maternal DHA intake on sleep organization has not been previously investigated. To examine the effect of a DHA-containing functional food consumed during pregnancy on early neurobehavioral development as assessed by infant sleep patterning in the first 48 postnatal hours. A longitudinal, randomized, double-blinded, placebo-controlled design was used. Women (18-35 y) with no pregnancy complications consumed a cereal-based functional food (92 kcal) containing 300 mg DHA an average of 5 d/week or placebo bars (n=27 DHA, n=21 Placebo). The intervention began at 24 weeks gestation and continued until delivery (38-40 weeks). Infant sleep/wake states were measured on postnatal days 1 (D1) and 2 (D2) using a pressure sensitive mattress recording respiration and body movements. Using ANCOVA and controlling for ethnic variation, there were significant group differences in arousals in quiet sleep on D1 (P=0.006) and D2 (P=0.011) with fewer arousals in the DHA intervention group compared to the placebo group. Similarly, arousals in active sleep on D1 were significantly lower in the DHA-intervention group (P=0.012) compared to the placebo group. We conclude that increased prenatal supply of dietary DHA has a beneficial impact on infant sleep organization.
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    ABSTRACT: Topic Sleeping behaviour Introduction Behaviour is the only way infants can communicate their needs to parents and other caregivers. Clinicians use changes in infant behaviours to alert them to possible medical complications that need further investigation, 1 and researchers use specific infant behaviours to identify pain 2 and responses to interventions that modify neonatal care. 3 Sleeping and waking not only affect the infant's immediate response to stimulation but, because they reflect the functioning of the central nervous system, have also been found to be related to developmental outcomes. 4-8 Subject More than 12% of births in the U.S. are premature (less than 37 weeks of gestation). The sleep of premature infants differs from that of full-term infants. These differences may continue after the neonatal hospitalization. Problem Sleeping and waking behaviours affect the development of preterm infants in multiple ways. First, sleeping and waking affect the infant's ability to respond to stimulation. Second, infants with neurological problems exhibit abnormal sleep patterns. Sleep and wakefulness may also have direct effects on brain development and learning that continue after the infant has been discharged home. Finally, differences in the sleep-wake patterns of preterm infants as compared to those of full-term infants might lead to sleep problems after hospital discharge. Key Research Questions Research is needed to describe the development of sleep and waking in preterm infants and to examine factors in the hospital and home environment that affect this development, the relationship between sleep development in preterm infants and other areas of psychosocial development, and to determine the extent to which sleep of prematurely born children continues to differ from that of children born at term after infancy and the degree to which these differences are related to sleep problems.
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