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Atalah YEY, Barış HE, Akdere SK, Sabancı M, Özdemir H, Gücüyener K, Eralp EE, Özek E, Boran P. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. J Clin Sleep Med 2023; 19:2075-2085. [PMID: 37559530 PMCID: PMC10692934 DOI: 10.5664/jcsm.10760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/16/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
STUDY OBJECTIVES To determine the differences in sleep patterns between preterm infants who received caffeine and those who did not and to evaluate the effects of caffeine therapy on early neurodevelopment. Secondarily, actigraphy and polysomnography were compared to evaluate the sleep of preterm infants. METHODS Twenty-eight preterm infants ages 28-34 weeks admitted to a single-center Level III neonatal intensive care unit between May 2020 and May 2021 were included. Sleep was assessed by actigraphy for 72 hours with Respironics Mini-Mitter® Actiwatch-2 and Brief Infant Sleep Questionnaire at 6 months corrected age. On the first day of actigraphy, infants underwent polysomnography between 10:00 am and 3:00 pm. Neurodevelopment was evaluated by the Bayley Scales of Infant and Toddler Development-III, the Ages & Stages Questionnaire, and the Hammersmith Infant Neurological Examination. RESULTS There were no significant differences in sleep parameters measured by actigraphy, the Brief Infant Sleep Questionnaire, and polysomnography between infants in the caffeine group (n = 12) and no-caffeine group (n = 16). Sensitivity (91.07%) and agreement rate (77.21%) for the actigraphy against polysomnography were highest at the automatic threshold. No significant differences were observed in the neurodevelopment of infants in the caffeine group compared to the no-caffeine group. CONCLUSIONS Sleep parameters and neurodevelopmental outcomes were not different in infants at 6 months of corrected age with regard to caffeine therapy. Actigraphy at the automatic threshold can be used in infants for sleep pattern assessment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Influence of Caffeine Therapy in Preterm Infants; URL: https://www.clinicaltrials.gov/ct2/show/NCT04376749; Identifier: NCT04376749. CITATION Atalah YEY, Barış HE, Akdere SK, et al. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. J Clin Sleep Med. 2023;19(12):2075-2085.
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Affiliation(s)
- Yaprak Ece Yola Atalah
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Hatice Ezgi Barış
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Selda Küçük Akdere
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Meltem Sabancı
- Marmara University, School of Medicine, Child Sleep Laboratory, Istanbul, Turkey
| | - Hülya Özdemir
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Kıvılcım Gücüyener
- Gazi University, School of Medicine, Division of Pediatric Neurology, Ankara, Turkey
| | - Ela Erdem Eralp
- Marmara University, School of Medicine, Department of Pediatrics, Division of Pediatric Pulmonology, Istanbul, Turkey
| | - Eren Özek
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Perran Boran
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
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Dias CC, Pinto TM, Figueiredo B. Maternal Prenatal Depressive Symptoms and Infant Sleep Problems: The Role of Infant Temperament and Sex. Behav Sleep Med 2023; 21:695-711. [PMID: 36533573 DOI: 10.1080/15402002.2022.2155162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to analyze whether (1) infant temperament mediates the impact of maternal prenatal depressive symptoms on infant sleep problems and (2) the mediation role of infant temperament was moderated by the infant's sex. METHODS The sample was comprised of 172 mother-infant dyads. Mothers completed self-reported measures of prenatal and postnatal depressive symptoms, infant temperament (negative affectivity, surgency/extraversion, and orienting regulation), and sleep problems. RESULTS While controlling for maternal postnatal depressive symptoms, our results revealed that (1) infant negative affectivity at two weeks partially mediated the impact of maternal prenatal depressive symptoms on sleep anxiety at six months, and (2) this mediation is independent of the infant's sex. CONCLUSIONS Our findings provided evidence that negative affectivity can be an early specific marker of sleep anxiety and can partially explain the negative impact of maternal prenatal depressive symptoms on further sleep problems in the infant.
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Affiliation(s)
| | - Tiago Miguel Pinto
- School of Psychology, University of Minho, Braga, Portugal
- Lusófona University, HEI-Lab, Porto, Portugal
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Hoshino K. Problems in the Development of the Sleep-Wake Rhythm Influence Neurodevelopmental Disorders in Children. Diagnostics (Basel) 2023; 13:diagnostics13111859. [PMID: 37296711 DOI: 10.3390/diagnostics13111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Development of the sleep-wake rhythm has a significant effect on the physical and mental development of children. The sleep-wake rhythm is controlled by aminergic neurons in the brainstem's ascending reticular activating system, which is associated with synaptogenesis and the promotion of brain development. The sleep-wake rhythm develops rapidly within the first year after birth. At 3-4 months of age, the framework of the circadian rhythm is established. The objective of the present review is to assess a hypothesis concerning problems in the development of the sleep-wake rhythm and their effect on neurodevelopmental disorders. Autism spectrum disorder is characterised by a delay in the development of sleep rhythms at 3-4 months of age and also insomnia and night-time awakenings, as supported by several reports. Melatonin may shorten the sleep latency in ASD. Rett syndrome sufferers kept awake during the daytime were analysed by the Sleep-wake Rhythm Investigation Support System (SWRISS) (IAC, Inc., (Tokyo, Japan)), and the cause was found to be the dysfunction of aminergic neurons. Children and adolescents with attention deficit hyperactivity disorder show sleep problems such as resistance to bedtime, difficulty falling asleep, sleep apnoea, and restless legs syndrome. Sleep deprivation syndrome in schoolchildren is deeply influenced by Internet use, games, and smartphones, and this syndrome affects emotion, learning, concentration, and executive functioning. Sleep disorders in adults are strongly considered to affect not only the physiological/autonomic nervous system but also neurocognitive/psychiatric symptoms. Even adults cannot avoid serious problems, much less children, and the impact of sleep problems is considerably greater in adults. Paediatricians and nurses should be aware of the significance, from birth, of sleep development and sleep hygiene education for carers and parents. This research was reviewed and approved by the ethical committee of the Segawa Memorial Neurological Clinic for Children (No. SMNCC23-02).
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Affiliation(s)
- Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo 101-0062, Japan
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Horne RS, Shetty M, Vandeleur M, Davey MJ, Walter LM, Nixon GM. Assessing sleep in children with Down syndrome: Comparison of parental sleep diaries, actigraphy and polysomnography. Sleep Med 2023; 107:309-315. [PMID: 37271108 DOI: 10.1016/j.sleep.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study compared measurements of sleep and wake assessed with actigraphy, sleep diary and polysomnography in children with Down syndrome (DS) and also compared measures of actigraphic sleep recording in children with DS and typically developing (TD) children. METHODS Children with DS aged 3-19 years (N = 44) referred for assessment of sleep disordered breathing (SDB) underwent overnight polysomnography, together with 1 week of actigraphy with sleep diary. Actigraphy data from the children with DS were compared with data collected from TD children, matched for age and sex. RESULTS 22 children (50%) with DS completed >3 consecutive nights of actigraphy with a matched sleep diary. There were no differences between bedtimes, wake times or time in bed on weeknights, weekends or over 7 nights between actigraphy and sleep diary. Total sleep time was over estimated by the sleep diary by almost 2 h and the number of night awakenings under-reported. Compared to matched TD children (N = 22), there was no difference in total sleep time, however children with DS fell asleep more quickly (p < 0.001), had more awakenings (p = 0.001) and more time awake after sleep onset (p = 0.007). Children with DS exhibited less variability in both bedtimes and wake times, and fewer had >1 h sleep schedule variability. CONCLUSIONS Parental sleep diaries over-estimate total sleep time but accurately report bed and wake times compared to actigraphy in children with DS. Children with DS have more regular sleep patterns than TD children of the same age, which is important for optimising daytime functioning. The reasons behind this warrant further investigation.
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Affiliation(s)
- Rosemary Sc Horne
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
| | - Marisha Shetty
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Moya Vandeleur
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
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Abstract
This article describes the changes in normal sleep regulation, structure, and organization and sleep-related changes in respiration from infancy to adolescence. The first 2 years of age are striking, with more time asleep than awake. With development, the electroencephalogram architecture has a marked reduction in rapid eye movement sleep and the acquisition of K-complexes, sleep spindles, and slow-wave sleep. During adolescence there is a reduction in slow-wave sleep and a delay in the circadian phase. Infants have a more collapsible upper airway and lower lung volumes than older children, which predisposes them to obstructive sleep apnea and sleep-related hypoxemia.
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Preschoolers' engagement with screen content and associations with sleep and cognitive development. Acta Psychol (Amst) 2022; 230:103762. [DOI: 10.1016/j.actpsy.2022.103762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/19/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022] Open
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Kamon M, Okada S, Furuta M, Yoshida K. Development of a non-contact sleep monitoring system for children. Front Digit Health 2022; 4:877234. [PMID: 36003190 PMCID: PMC9393414 DOI: 10.3389/fdgth.2022.877234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Daily monitoring is important, even for healthy children, because sleep plays a critical role in their development and growth. Polysomnography is necessary for sleep monitoring. However, measuring sleep requires specialized equipment and knowledge and is difficult to do at home. In recent years, smartwatches and other devices have been developed to easily measure sleep. However, they cannot measure children's sleep, and contact devices may disturb their sleep.A non-contact method of measuring sleep is the use of video during sleep. This is most suitable for the daily monitoring of children’s sleep, as it is simple and inexpensive. However, the algorithms have been developed only based on adult sleep, whereas children’s sleep is known to differ considerably from that of adults.For this reason, we conducted a non-contact estimation of sleep stages for children using video. The participants were children between the ages of 0–6 years old. We estimated the four stages of sleep using the body movement information calculated from the videos recorded. Six parameters were calculated from body movement information. As children’s sleep is known to change significantly as they grow, estimation was divided into two groups (0–2 and 3–6 years).The results show average estimation accuracies of 46.7 ± 6.6 and 49.0 ± 4.8% and kappa coefficients of 0.24 ± 0.11 and 0.28 ± 0.06 in the age groups of 0–2 and 3–6 years, respectively. This performance is comparable to or better than that reported in previous adult studies.
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Affiliation(s)
- Masamitsu Kamon
- Department of Robotics, Ritsumeikan University, Shiga, Japan
- Correspondence: Masamitsu Kamon
| | - Shima Okada
- Department of Robotics, Ritsumeikan University, Shiga, Japan
| | - Masafumi Furuta
- Technology Research Laboratory, Shimadzu Corporation, Kyoto, Japan
| | - Koki Yoshida
- Technology Research Laboratory, Shimadzu Corporation, Kyoto, Japan
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Rojo-Wissar DM, Bai J, Benjamin-Neelon SE, Wolfson AR, Spira AP. Development of circadian rest-activity rhythms during the first year of life in a racially diverse cohort. Sleep 2022; 45:zsac078. [PMID: 35380731 PMCID: PMC9189964 DOI: 10.1093/sleep/zsac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/26/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To describe the development of circadian rest-activity rhythms (CRARs) during infancy in a racially diverse cohort. METHODS We studied 414 infants from the Nurture birth cohort (51.2% female, 65.2% Black) who wore actigraphs on their left ankles for 4 days and nights at 3, 6, 9, and 12 months. We quantified CRARs using cosinor and non-parametric circadian rhythm analysis, and investigated change in CRARs over time, comparing 6, 9, and 12 months to CRARs at 3 months. We adjusted for baseline and time-varying covariates and used function-on-scalar regression (FOSR) to identify the specific times of day at which activity changes occurred. RESULTS Across the first year, daily mean and peak activity levels and day-to-day activity level regularity increased, and activity level fragmentation and nighttime activity decreased. Only at 9 months, compared to at 3 months, did timing of peak activity levels and the most active periods shift later, while timing of least active periods shifted earlier. FOSR analyses showed that mean activity levels decreased during nighttime hours and increased during daytime hours, with the most pronounced changes at 9 months. CONCLUSIONS Among racially diverse infants, CRARs became more robust, stable, and less fragmented over time. Findings suggest the greatest change from 3-month CRARs occurs at 9 months, which may be a key period of CRAR development. This and future research will contribute to our understanding of normative infant CRAR development in diverse populations and enable us to identify infants who may benefit from intervention.
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Affiliation(s)
- Darlynn M Rojo-Wissar
- The Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital, Providence, RI, USA
- E.P. Bradley Hospital Sleep Research Laboratory, Providence, RI, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,USA
| | - Jiawei Bai
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,USA
| | - Amy R Wolfson
- Department of Psychology, Loyola College of Arts and Sciences, Loyola University Maryland
, Baltimore, MD,
USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD,USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD,USA
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9
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Cassels T, Rosier JG. The Effectiveness of Sleep Training: Fact or Fiction? CLINICAL LACTATION 2022. [DOI: 10.1891/cl-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IntroductionIn Western cultures, parents often view infant sleep as problematic. Family, friends, and doctors may advise parents to “sleep train” assuming it is safe and effective, without considering its possible side effects, including its impact on breastfeeding. Unfortunately, it may reduce night feeds and result in earlier supplementation or weaning. The larger question is whether sleep training is worth the risk (i.e., does it improve infant sleep?). Our goal was to examine the data on the effectiveness of sleep training interventions on infant/toddler sleep.MethodsPubMed and Google Scholar were searched for specific terms to identify articles that included behavioral sleep interventions and objective measures of sleep pre-and postntervention. Two objective infant sleep measures were examined: Night wakings and total sleep duration. Articles were then reviewed for evidence of the effectiveness of these interventions to reduce night wakings and increase total sleep duration.ResultsFive articles were identified that met the criteria for inclusion. Overall, there was no evidence that sleep training improves infant sleep.Applications for PracticeThe claim that sleep training is effective in changing infant sleep is not warranted. Given the potential side effects on breastfeeding, parents should be cautioned about engaging these behavioral sleep interventions if they have breastfeeding goals they want to achieve.
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Bucko AG, Dowda M, Frongillo EA, Torres ME, Pate RR. Nighttime sleep and physical activity in 6-7 month-old infants. Infant Behav Dev 2021; 65:101628. [PMID: 34392076 PMCID: PMC8627435 DOI: 10.1016/j.infbeh.2021.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
This study examined associations between objectively-measured nighttime sleep duration and physical activity in a sample of 6-7 month-old infants (N=93). The study also investigated relationships between infant sleep and demographic and environmental characteristics. Cross-sectional relationships were assessed using linear regression analyses. Nighttime sleep duration was positively associated with physical activity levels. Nighttime sleep duration was greater when infants had a consistent bedtime, slept in a separate room, were male, and had mothers who reported having a college education or greater. These findings can inform the development of interventions that aim to improve infant sleep.
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Affiliation(s)
- Agnes G Bucko
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Marsha Dowda
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Myriam E Torres
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Russell R Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Lujan MR, Perez-Pozuelo I, Grandner MA. Past, Present, and Future of Multisensory Wearable Technology to Monitor Sleep and Circadian Rhythms. Front Digit Health 2021; 3:721919. [PMID: 34713186 PMCID: PMC8521807 DOI: 10.3389/fdgth.2021.721919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022] Open
Abstract
Movement-based sleep-wake detection devices (i.e., actigraphy devices) were first developed in the early 1970s and have repeatedly been validated against polysomnography, which is considered the “gold-standard” of sleep measurement. Indeed, they have become important tools for objectively inferring sleep in free-living conditions. Standard actigraphy devices are rooted in accelerometry to measure movement and make predictions, via scoring algorithms, as to whether the wearer is in a state of wakefulness or sleep. Two important developments have become incorporated in newer devices. First, additional sensors, including measures of heart rate and heart rate variability and higher resolution movement sensing through triaxial accelerometers, have been introduced to improve upon traditional, movement-based scoring algorithms. Second, these devices have transcended scientific utility and are now being manufactured and distributed to the general public. This review will provide an overview of: (1) the history of actigraphic sleep measurement, (2) the physiological underpinnings of heart rate and heart rate variability measurement in wearables, (3) the refinement and validation of both standard actigraphy and newer, multisensory devices for real-world sleep-wake detection, (4) the practical applications of actigraphy, (5) important limitations of actigraphic measurement, and lastly (6) future directions within the field.
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Affiliation(s)
- Matthew R Lujan
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Ignacio Perez-Pozuelo
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.,Department of Medicine, The Alan Turing Institute, London, United Kingdom
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
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Esaki S, Nakayama M, Arima S, Sato S. Use of Actigraphy for a Rat Behavioural Sleep Study. Clocks Sleep 2021; 3:409-414. [PMID: 34449568 PMCID: PMC8395400 DOI: 10.3390/clockssleep3030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/10/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Previous studies of animal behavioural sleep is mainly divided into two study types, observation by video recording or counts by sensor, both of which require a complex environment and procedure. An actigraph unit is a commercially available product which can provide non-invasive monitoring human rest/activity cycles. The goal of this study was to evaluate whether actigraphy can be applied for analysing behavioural sleep in rats, since no reports have described utilization of the actigraphy unit for monitoring sleep of small animals. The actigraph unit was held on the chest of eight male rats by a loose elastic belt. The rats spent two days in a normal condition, followed by two days of sleep deprivation. Total counts measured by the actigraph could be clearly divided into two phases, sleep phase and awake phase, when the rats were kept in the normal cage. Next, the rats were moved into the sleep-deviation cage, and the total counts were significantly higher during daytime, indicating the successful induction of sleep deprivation. These results showed that the actigraphy unit monitored rest/activity cycles of rats, which will contribute to making sleep behaviour experiments easier.
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Affiliation(s)
- Shinichi Esaki
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya 467-8601, Japan; (S.E.); (M.N.); (S.A.)
- Good Sleep Center, Nagoya City University Hospital, Nagoya 467-8602, Japan
- Department of Virology, Graduate School of Medicine, Nagoya University, Nagoya 464-8550, Japan
| | - Meiho Nakayama
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya 467-8601, Japan; (S.E.); (M.N.); (S.A.)
- Good Sleep Center, Nagoya City University Hospital, Nagoya 467-8602, Japan
- Meiho Sleep & Balance Clinic, Nagoya 450-0002, Japan
| | - Sachie Arima
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya 467-8601, Japan; (S.E.); (M.N.); (S.A.)
- Good Sleep Center, Nagoya City University Hospital, Nagoya 467-8602, Japan
| | - Shintaro Sato
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya 467-8601, Japan; (S.E.); (M.N.); (S.A.)
- Good Sleep Center, Nagoya City University Hospital, Nagoya 467-8602, Japan
- Correspondence: ; Tel.: +81-52-853-8256
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Menici V, Antonelli C, Beani E, Mattiola A, Giampietri M, Martini G, Rizzi R, Cecchi A, Cioni ML, Cioni G, Sgandurra G. Feasibility of Early Intervention Through Home-Based and Parent-Delivered Infant Massage in Infants at High Risk for Cerebral Palsy. Front Pediatr 2021; 9:673956. [PMID: 34350144 PMCID: PMC8328146 DOI: 10.3389/fped.2021.673956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Infant massage (IM) can be considered an early intervention program that leads to the environmental enrichment framework. The effectiveness of IM to promote neurodevelopment in preterm infants has been proved, but studies on infants with early brain damage are still lacking. The main aim of this study was to assess the feasibility, acceptability and usability of IM, carried out by parents at home, on infants at high risk for Cerebral Palsy. An IM daily diary and an ad hoc questionnaire, called Infant Massage Questionnaire Parent-Infant Experiences (IMQPE), were developed. IMQPE consisted of a total of 30 questions, divided into 5 areas. The parents were trained to carry out the IM with a home-based course, conducted by an expert therapist. The intensive IM program was set according to a defined daily length of at least 20 min, with a frequency of at least 5 days per week for a total of 8 weeks. Data collection consisted in the selection of the variables around the characteristics, both of the infants and the mothers, IM dosage and frequency, different body parts of the infants involved and IMQPE scores. Variable selection was carried out by minimizing the Bayesian Information Criteria (BIC) over all possible variable subsets. Nineteen high-risk infants, aged 4.83 ± 1.22 months, received IM at home for 8 weeks. The massage was given by the infants' mothers with a mean daily session dose of 27.79 ± 7.88 min and a total of 21.04 ± 8.49 h. 89.74% and 100% of mothers performed the IM for the minimum daily dosage and the frequency recommended, respectively. All the families filled in the IMQPE, with a Total mean score of 79.59% and of 82.22% in General Information on IM, 76.30% in Infant's intervention-related changes, 76.85% in IM Suitability, 79.07% in Infant's acceptance and 83.52% in Time required for the training. Different best predictors in mothers and in infants have been found. These data provide evidence of the feasibility of performing IM at home on infants at high risk for CP. Study registration: www.clinicaltrial.com (NCT03211533 and NCT03234959).
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Affiliation(s)
- Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Camilla Antonelli
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Mattiola
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Giada Martini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Riccardo Rizzi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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14
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Studying caregiver-infant co-regulation in dynamic, diverse cultural contexts: A call to action. Infant Behav Dev 2021; 64:101586. [PMID: 34118652 DOI: 10.1016/j.infbeh.2021.101586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 01/17/2023]
Abstract
Caregivers and infants co-regulate their physiology, emotions, and behavior in a way that is dynamically responsive to each other and the contexts in which they live. This paper is an introduction and call to action for researchers interested in understanding how to study caregiver-infant interactions in the home and diverse cultural contexts, including marginalized communities. We argue that research will be more valid, culturally relevant, and tapped-in to the daily lives of caregivers and infants if there is partnership and collaboration with the caregivers in the design of the questions, data collection and analysis, and distribution of the findings. We recommend dynamically assessing emotions, behaviors, and physiology using repeated sampling methods including ecological momentary assessments (EMA), salivary bioscience, and actigraphy. We aim to extend current practices of studying caregiver-infant co-regulation by measuring fluctuations of daily life and considering sociocultural factors that shape naturalistic caregiver-infant interactions. Using methodological advancements and community-based participatory research approaches can enable developmental scientists to measure life as it is actually lived.
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15
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Quante M, Hong B, von Ash T, Yu X, Kaplan ER, Rueschman M, Jackson CL, Haneuse S, Davison K, Taveras EM, Redline S. Associations between parent-reported and objectively measured sleep duration and timing in infants at age 6 months. Sleep 2021; 44:zsaa217. [PMID: 33098646 PMCID: PMC8033447 DOI: 10.1093/sleep/zsaa217] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/08/2020] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVES To compare the estimates of sleep duration and timing from survey, diary, and actigraphy in infants at age 6 months, overall and by select demographics and other factors. METHODS In total, 314 infants participating in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort in Boston, MA, USA, wore an actigraph on their left ankle for 7 days. Parents concurrently completed a sleep diary and the expanded version of the Brief Infant Sleep Questionnaire. Concordance between parent-reported and objective sleep estimates was assessed using Bland-Altman plots, Spearman's rank correlations, intraclass correlations, and linear regression models. RESULTS Mean infant age was 6.4 (0.6 SD) months; 51% were female and 42% were Non-Hispanic white. Mean total sleep duration using actigraphy was 526 (67 SD) minutes per night, 143 (42 SD) minutes per day, and 460 (100 SD) minutes during the longest nighttime sleep period. Relative to actigraphy, parent-completed survey and diary overestimated total day (by 29 and 31 minutes, respectively) and night sleep duration (67 and 43 minutes, respectively) and underestimated the longest sleep (58 minutes), with the highest agreement for sleep onset and offset timing (differences < 30 minutes). There was a tendency toward greater bias among short- and long-sleeping infants. Self-reporting bias for diary-measured longest nighttime sleep and total night sleep duration was higher in infants of parents reporting a problem with their baby's night awakenings and in low-income families, respectively. CONCLUSIONS Our findings underscore the need to be cautious when comparing findings across studies using different sleep assessment methods.
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Affiliation(s)
- Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Benjamin Hong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tayla von Ash
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Xinting Yu
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Emily R Kaplan
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Michael Rueschman
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
| | - Chandra L Jackson
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
- Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Elsie M Taveras
- Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham & Women’s Hospital & Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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16
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Yu X, Quante M, Rueschman M, Ash T, Kaplan ER, Guo N, Horan CM, Haneuse S, Davison K, Taveras EM, Redline S. Emergence of racial/ethnic and socioeconomic differences in objectively measured sleep-wake patterns in early infancy: results of the Rise & SHINE study. Sleep 2021; 44:zsaa193. [PMID: 33057653 PMCID: PMC7953214 DOI: 10.1093/sleep/zsaa193] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/30/2020] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES To characterize objectively assessed sleep-wake patterns in infants at approximately 1 month and 6 months and examine the differences among infants with different racial/ethnic backgrounds and household socioeconomic status (SES). METHODS Full-term healthy singletons wore an ankle-placed actigraph at approximately 1 month and 6 months and parents completed sleep diaries. Associations of racial/ethnic and socioeconomic indices with sleep outcomes were examined using multivariable analyses. Covariates included sex, birth weight for gestational age z-score, age at assessment, maternal education, household income, bed-sharing, and breastfeeding. RESULTS The sample included 306 infants, of whom 51% were female, 42.5% non-Hispanic white, 32.7% Hispanic, 17.3% Asian, and 7.5% black. Between 1 month and 6 months, night sleep duration increased by 65.7 minutes (95% CI: 55.4, 76.0), night awakenings decreased by 2.2 episodes (2.0, 2.4), and daytime sleep duration decreased by 73.3 minutes (66.4, 80.2). Compared to change in night sleep duration over this development period for white infants (82.3 minutes [66.5, 98.0]), night sleep increased less for Hispanic (48.9 minutes [30.8, 66.9]) and black infants (31.6 minutes [-5.9, 69.1]). Night sleep duration also increased less for infants with lower maternal education and household income. Asian infants had more frequent night awakenings. Adjustment for maternal education and household income attenuated all observed day and night sleep duration differences other than in Asians, where persistently reduced nighttime sleep at 6 months was observed. CONCLUSIONS Racial/ethnic differences in sleep emerge in early infancy. Night and 24-hour sleep durations increase less in Hispanic and black infants compared to white infants, with differences largely explained by SES.
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Affiliation(s)
- Xinting Yu
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- School of Social Work, Boston College, Chestnut Hill, MA
| | - Mirja Quante
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Michael Rueschman
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Tayla Ash
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI
| | - Emily R Kaplan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Na Guo
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Christine M Horan
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kirsten Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- School of Social Work, Boston College, Chestnut Hill, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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17
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Kracht CL, Redman LM, Casey PH, Krukowski RA, Andres A. Association between Home Environment in Infancy and Child Movement Behaviors. Child Obes 2021; 17:100-109. [PMID: 33471594 PMCID: PMC7984654 DOI: 10.1089/chi.2020.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.
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Affiliation(s)
| | | | - Patrick H. Casey
- Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, USA
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, USA.,Address correspondence to: Aline Andres, PhD, RD, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, 15 Children's Way, Slot 512-20B, Little Rock, AR 72202, USA
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18
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Frost S, Saddi V, Teng A, Mallitt KA, Adams S, Williamson B, Wargon O. Propranolol's effects on the sleep of infants with hemangiomas: A prospective pilot study. Pediatr Dermatol 2021; 38:371-377. [PMID: 33351238 DOI: 10.1111/pde.14484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess propranolol's impact on sleep when used in infants and toddlers with infantile hemangioma (80% under 6 months old). METHODS Parents and caregivers of infants and toddlers with infantile hemangioma presenting to a tertiary pediatric hospital's dermatology clinic and assessed by their dermatologist as requiring propranolol treatment were invited to participate. All participants completed an extended version of the Brief Infant Sleep Questionnaire (BISQ) prior to propranolol treatment initiation, which acted as the control, and 5 weeks after treatment commencement. Objective data were gathered through actigraphy, which utilizes a small wristwatch-like device that measures sleep-wake patterns, for 1 week prior to initiation and again 5 weeks after commencement. BISQ responses and actigraphy values from the two time points were compared. RESULTS 55 infants and toddlers (aged 0-2.8 years, 80% under 6 months) were included. Sleep was reported as only a minor problem by most parents 5 weeks after starting propranolol (P = .049). Subgroup analysis of 45 infants <6 months old showed no significant difference in sleep while taking propranolol. Whole cohort BISQ data analysis showed a statistically significant increase in night-time sleep (P = .024), and a decrease in the number (P = .003) and duration of daytime naps (P = .025) following commencement of propranolol. Actigraphy data completed in 10 infants showed no significant difference in sleep quality before and 5 weeks after commencing propranolol. CONCLUSION Propranolol did not significantly impair sleep quality and pattern in our cohort of infants and toddlers with infantile hemangioma. Most parents considered the impact on sleep to be only a minor problem.
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Affiliation(s)
- Stephanie Frost
- UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Vishal Saddi
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Sydney Children's Hospital, Randwick, NSW, Australia
| | - Arthur Teng
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kylie-Ann Mallitt
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Sydney Children's Hospital, Randwick, NSW, Australia
| | - Susan Adams
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Orli Wargon
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Sydney Children's Hospital, Randwick, NSW, Australia
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19
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Horger MN, DeMasi A, Allia AM, Scher A, Berger SE. Newly walking infants' night sleep impacts next day learning and problem solving. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:57-83. [PMID: 33641800 DOI: 10.1016/bs.acdb.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sleep is part of the process that prepares children and adults for next day cognitive activity. Insufficient or fragmented sleep has a detrimental impact on subsequent encoding (Rouleau et al., 2002) and cognitive functioning (Joo et al., 2012). However, fragmented sleep early in life is a developmental norm, limiting the extent to which conclusions derived from older populations can be generalized. To directly test the continuity of this relationship, newly-walking infants' (N=58) sleep was monitored overnight using actigraphy. The next morning they were taught a motor problem-solving task. The task required infants to navigate through a tunnel to reach a goal at the other end. We coded infants' exploratory behaviors and the extent of training required to solve the task. Using a cluster analysis that accounted for exploratory behaviors and number of training prompts, infants were sorted into three profiles: those who found the task Easy to solve, those who found it Difficult, and those who Never solved it. Wake episodes and sleep efficiency were entered as predictors of cluster membership in a multinomial logistic regression. Of the infants who ultimately solved the task, those with more wake episodes and lower sleep efficiency had more difficulty. Specifically, fragmentation appeared to negatively impact preparedness to learn. Contrary to our expectations, infants who Never solved the task had the least fragmented sleep, indicating that an optimal level of fragmentation is needed for efficient problem-solving. For infants, some level of sleep fragmentation is needed the night before learning in order to solve a task efficiently. These findings highlight the interaction between developmental domains, from sleep quality to motor experience, and their impact on infant learning in real time.
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Affiliation(s)
- Melissa N Horger
- The Graduate Center, City University of New York (CUNY), New York, NY, United States.
| | - Aaron DeMasi
- The Graduate Center, City University of New York (CUNY), New York, NY, United States
| | - Angelina M Allia
- The College of Staten Island, CUNY, Staten Island, NY, United States
| | - Anat Scher
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Sarah E Berger
- Department of Psychology, The College of Staten Island and the Graduate Center of the City University of New York, NY, United States
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20
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Beani E, Menici V, Cecchi A, Cioni ML, Giampietri M, Rizzi R, Sgandurra G, Cioni G. Feasibility Analysis of CareToy-Revised Early Intervention in Infants at High Risk for Cerebral Palsy. Front Neurol 2020; 11:601137. [PMID: 33391164 PMCID: PMC7772394 DOI: 10.3389/fneur.2020.601137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022] Open
Abstract
Infants with perinatal brain injury are at high risk for Cerebral Palsy (CP). Progresses in detection of early signs of brain injury and of CP allow early intervention (EI) programs for improving the outcome of these infants. CareToy system (CT), developed within a European project (Trial Registration: NCT01990183), allows providing, by means of tele-rehabilitation, a highly personalized, family-centered, home-based EI for young infants, remotely managed by clinicians. CareToy, already used with pre-terms without brain injury, has been adapted for high-risk infants in a project funded by the Italian Ministry of Health, and the CareToy-Revised (CareToy-R) has been realized (Trial registration: NCT03211533 and NCT03234959). Before assessing its efficacy, it was crucial to evaluate the acceptability, usability, and feasibility of CareToy-R EI. Nineteen high-risk infants with perinatal brain injury, aged 5.95 ± 2.13 months (range 3.12–10.78 months), carried out an 8-week training with CareToy-R at home, performing customized playful activities with their parents, tailored to their rehabilitative needs, remotely managed by clinicians. The feasibility of training and study procedures was assessed through criteria derived from literature; acceptability and usability have been analyzed from data about individual training and an ad hoc questionnaire. All CareToy-R trainings were planned by the clinical staff with a daily personalized use for each infant between 30 and 45 min (mean 34.37 min). The amount of executed training by the infants was very high (daily mean 30.30 min), with no differences related to infant age, sex, and gestational age. All the nine feasibility criteria were achieved, family compliance to the project was very good, data collection was completed and the CareToy-R system worked properly and easily for parents. The answers to the questionnaire had a total mean score of 84.49% and they ranged from a minimum of 81.05% (in “easy to use” area) to a maximum of 86.49% (“changes due to the training” area), with no differences related to nationality or familiarity with technology of the mothers. This study reports preliminary evidence to the feasibility of a home-based EI with CareToy-R system in infants at high risk for CP. Results of the RCT will provide data about the potential effectiveness of this approach.
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Affiliation(s)
- Elena Beani
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Valentina Menici
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Riccardo Rizzi
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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21
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Dall'Orso S, Fifer WP, Balsam PD, Brandon J, O'Keefe C, Poppe T, Vecchiato K, Edwards AD, Burdet E, Arichi T. Cortical Processing of Multimodal Sensory Learning in Human Neonates. Cereb Cortex 2020; 31:1827-1836. [PMID: 33207366 PMCID: PMC7869081 DOI: 10.1093/cercor/bhaa340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
Following birth, infants must immediately process and rapidly adapt to the array of unknown sensory experiences associated with their new ex-utero environment. However, although it is known that unimodal stimuli induce activity in the corresponding primary sensory cortices of the newborn brain, it is unclear how multimodal stimuli are processed and integrated across modalities. The latter is essential for learning and understanding environmental contingencies through encoding relationships between sensory experiences; and ultimately likely subserves development of life-long skills such as speech and language. Here, for the first time, we map the intracerebral processing which underlies auditory-sensorimotor classical conditioning in a group of 13 neonates (median gestational age at birth: 38 weeks + 4 days, range: 32 weeks + 2 days to 41 weeks + 6 days; median postmenstrual age at scan: 40 weeks + 5 days, range: 38 weeks + 3 days to 42 weeks + 1 days) with blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (MRI) and magnetic resonance (MR) compatible robotics. We demonstrate that classical conditioning can induce crossmodal changes within putative unimodal sensory cortex even in the absence of its archetypal substrate. Our results also suggest that multimodal learning is associated with network wide activity within the conditioned neural system. These findings suggest that in early life, external multimodal sensory stimulation and integration shapes activity in the developing cortex and may influence its associated functional network architecture.
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Affiliation(s)
- S Dall'Orso
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg 412 96, Sweden
| | - W P Fifer
- Department of Psychiatry, Columbia University, New York 10032, NY
| | - P D Balsam
- Department of Psychiatry, Columbia University, New York 10032, NY
| | - J Brandon
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK
| | - C O'Keefe
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK
| | - T Poppe
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK
| | - K Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK
| | - A D Edwards
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK
| | - E Burdet
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - T Arichi
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK.,Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Kings College London, London SE1 7EH, UK.,Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London SE1 7EH, UK
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22
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Toro-Campos R, Algarín C, Peirano P, Peña M, Murguia-Peniche T, Wu SS, Uauy R. Effect of feeding mode on infant growth and cognitive function: study protocol of the Chilean infant Nutrition randomized controlled Trial (ChiNuT). BMC Pediatr 2020; 20:225. [PMID: 32423392 PMCID: PMC7236373 DOI: 10.1186/s12887-020-02087-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A central aim for pediatric nutrition is to develop infant formula compositionally closer to human milk. Milk fat globule membranes (MFGM) have shown to have functional components that are found in human milk, suggesting that addition of bovine sources of MFGM (bMFGM) to infant formula may promote beneficial outcomes potentially helping to narrow the gap between infants who receive human breast milk or infant formula. The objective of the current study is to determine how the addition of bMFGM in infant formula and consumption in early infancy affects physical growth and brain development when compared to infants fed with a standard formula and a reference group of infants fed with mother's own milk. METHODS Single center, double-blind, and parallel randomized controlled trial. Planned participant enrollment includes: infants exclusively receiving breast milk (n = 200; human milk reference group; HM) and infants whose mothers chose to initiate exclusive infant formula feeding before 4 months of age (n = 340). The latter were randomized to receive one of two study formulas until 12 months of age: 1) cow's milk based infant formula that had docosahexaenoic (DHA) (17 mg/100 kcal) and arachidonic acid (ARA) (25 mg/100 kcal); 1.9 g protein/100 kcal; 1.2 mg Fe/100 kcal (Standard formula; SF) or 2) a similar infant formula with an added source of bovine MFGM (whey protein-lipid concentrate (Experimental formula; EF). Primary outcomes will be: 1) Physical growth (Body weight, length, and head circumference) at 730 days of age; and 2) Cognitive development (Auditory Event-Related Potential) at 730 days of age. Data will be analyzed for all participants allocated to each study feeding group. DISCUSSION The results of this study will complement the knowledge regarding addition of bMFGM in infant formula including support of healthy growth and improvement of neurodevelopmental outcomes. TRIAL REGISTRATION NCT02626143, registered on December 10th 2015.
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Affiliation(s)
- Rosario Toro-Campos
- Institute of Nutrition and Food Technology (INTA), University of Chile, Av El Libano 5524, Macul, Santiago, Chile
| | - Cecilia Algarín
- Institute of Nutrition and Food Technology (INTA), University of Chile, Av El Libano 5524, Macul, Santiago, Chile
| | - Patricio Peirano
- Institute of Nutrition and Food Technology (INTA), University of Chile, Av El Libano 5524, Macul, Santiago, Chile
| | - Marcela Peña
- Psychology Department, Pontific Catholic University, Santiago, Chile
| | | | - Steven S. Wu
- Medical Affairs, Mead Johnson Nutrition, Evansville, IN USA
| | - Ricardo Uauy
- Institute of Nutrition and Food Technology (INTA), University of Chile, Av El Libano 5524, Macul, Santiago, Chile
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23
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Armstrong B, Covington LB, Unick GJ, Black MM. Featured Article: Bidirectional Effects of Sleep and Sedentary Behavior Among Toddlers: A Dynamic Multilevel Modeling Approach. J Pediatr Psychol 2020; 44:275-285. [PMID: 30476202 DOI: 10.1093/jpepsy/jsy089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To examine the bidirectional effects of objectively measured nighttime sleep and sedentary activity among toddlers. METHOD Actical accelerometer data were analyzed for 195 toddlers participating in an obesity prevention trial (mean age = 27 months). Toddlers wore the accelerometers for up to 7 consecutive days. Nighttime sleep was defined as the number of minutes asleep between the hours of 8 pm and 8 am the following morning. Sedentary behavior (in minutes) was defined using previously established Actical cut points for toddlers. Variables were lagged and parsed into latent within- and between-person components, using dynamic structural equation modeling (DSEM). RESULTS Toddlers spent an average of 172 min (∼3 hr) in sedentary activity and slept an average of 460 min (∼8 hr) per night. An autoregressive cross-lagged multilevel model revealed significant autoregression for both sleep and sedentary activity. Cross-lagged values revealed that decreased sleep predicted increased next-day sedentary activity, and sedentary activity predicted that night's sleep. For 89% of the sample, the within-person standardized cross-lagged effects of sleep on sedentary were larger than the cross-lagged effects of sedentary on sleep. CONCLUSIONS Results suggest that, on average, nighttime sleep is a stronger predictor of subsequent sedentary behavior (compared with the reverse), and this is the case for the majority of toddlers. Findings highlight the importance of interindividual associations between sleep and sedentary activity. The present study is an example of how DSEM methods can be used to ask questions about Granger-causal cross-lagged relations between variables, both within and between individuals.
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Affiliation(s)
| | | | | | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine.,RTI International
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Bruijns BA, Truelove S, Johnson AM, Gilliland J, Tucker P. Infants' and toddlers' physical activity and sedentary time as measured by accelerometry: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:14. [PMID: 32028975 PMCID: PMC7006115 DOI: 10.1186/s12966-020-0912-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early experiences in physical activity (PA) are important to shape healthy movement behaviours long-term; as such, it is critical that PA is promoted from infancy, and that detrimental behaviours (e.g., prolonged sedentary time [ST]) are minimized. The purpose of this systematic review and meta-analysis was to examine infants' and toddlers' movement behaviours across daytime hours. METHODS Seven online databases were searched for terms related to infants (< 12 months), toddlers (12-35.9 months), PA, ST, and accelerometry. Two independent reviewers examined 4873 articles for peer-reviewed original research, published in English, that assessed infants' (counts/min) and/or toddlers' PA or ST (min/day) using accelerometry across daytime hours. Infants' mean PA level (counts/min) was averaged across studies, and ranges were produced. Estimates of toddlers' movement behaviours were aggregated meta-analytically to produce average daily rates, and accelerometer placement, cut-point validity, device type, and epoch length were tested as a moderating variables. RESULTS Twenty-four studies from 16 countries (published 2011-2019), representing 3699 participants, were included in the systematic review. Five studies reported on infants' PA, which ranged from 78.2 to 2580.5 cpm. Across 20 studies, toddlers' total PA, light PA, moderate-to vigorous-intensity PA, and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After taking into account accelerometer placement, cut-point validity, device type, and epoch length, we found that toddlers engaged in 246.19 min/day (SE = 28.50; 95% CI: 190.34, 302.04) of total PA, 194.10 min/day (SE = 28.76; 95% CI: 137.73, 250.47) of light PA, and 60.16 min/day (SE = 5.88; 95% CI: 48.64, 71.69) of moderate-to vigorous-intensity PA. Toddlers engaged in 337.04 min/day (SE = 32.67; 95% CI: 273.01, 401.07) of ST. CONCLUSIONS With limited studies conducted in infants (n = 5), PA estimates are inconclusive and largely heterogeneous. Overall, toddlers tend to exceed the total PA recommendation of 180 min/day; however, very little of this time is spent at higher movement intensities. Even with high PA rates, toddlers still engage in substantial ST. More consistent and valid measurement protocols are needed to improve comparability across studies.
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Affiliation(s)
- Brianne A. Bruijns
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario Canada
| | - Stephanie Truelove
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario Canada
| | - Andrew M. Johnson
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario Canada
| | - Jason Gilliland
- Department of Geography, Faculty of Social Sciences, University of Western Ontario, London, Ontario Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON N6G 1H1 Canada
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Fujii S, Watanabe H, Taga G. Wearable strain sensor suit for infants to measure limb movements under interaction with caregiver. Infant Behav Dev 2020; 58:101418. [PMID: 31935592 DOI: 10.1016/j.infbeh.2019.101418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
Abstract
Development of motion capture technology has enabled the measurement of body movements over long periods of time in daily life. Although accelerometers have been used as primary sensors, problems arise when they are used to measure the movements of infants. Because infants and caregivers interact frequently, accelerometer data from infants may be significantly distorted by a caregiver's movement. To overcome this problem, a strain sensor suit was developed for infants to measure flexion and extension movements of the limbs. A case study was performed to analyze the strain sensor data of an infant in relation to the accelerometer data of the infant's and a caregiver's body under various types of infant-caregiver interaction. The results demonstrated that the strain sensor data had low correlation with the accelerometer data of the infant and caregiver while the accelerometer data between infant and caregiver had higher correlation. This suggests that the strain sensor is suitable to detect limbs' angular displacements mostly independent from the translational body movements exerted by a caregiver.
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Affiliation(s)
- Shinya Fujii
- Faculty of Environmental and Information Studies, Keio University, Kanagawa, Japan
| | - Hama Watanabe
- Graduate School of Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Gentaro Taga
- Graduate School of Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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Santos IS, Del-Ponte B, Tovo-Rodrigues L, Halal CS, Matijasevich A, Cruz S, Anselmi L, Silveira MF, Hallal PRC, Bassani DG. Effect of Parental Counseling on Infants' Healthy Sleep Habits in Brazil: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1918062. [PMID: 31860110 PMCID: PMC6991232 DOI: 10.1001/jamanetworkopen.2019.18062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/30/2019] [Indexed: 12/22/2022] Open
Abstract
Importance Poor sleep during early childhood is associated with adverse outcomes, including obesity, cognitive impairment, and mental and behavioral disorders. Objective To assess the efficacy of an educational intervention in the promotion of nighttime sleep duration. Design, Setting, and Participants This single-blind, intent-to-treat randomized clinical trial included participants in Pelotas, Brazil, aged 3 months who were followed up until age 24 months. Eligibility criteria included healthy infants aged approximately 3 months who slept less than 15 hours per 24 hours. Infants were randomized to the intervention group or control group. Interventions Information on sleep characteristics, improvements in the environment, establishment of a nighttime sleep routine, and waiting before attending nocturnal awakenings was delivered to mothers in the intervention group by trained home-visitors at baseline. The intervention group received a telephone call on the first and second day after the intervention and a home visit on the third day after the intervention. The intervention's content was reinforced at health care visits for ages 6 months and 12 months. Mothers allocated to the control group were counseled on the benefits of breastfeeding for the mother's and child's health and given written material with content on breastfeeding. Main Outcomes and Measures Nighttime sleep duration was measured by interview and actigraphy at baseline and ages 6, 12, and 24 months and diaries at baseline and age 6 months. At ages 3 and 6 months, nighttime sleep self-regulation was calculated by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration recorded in the diaries and at ages 12 and 24 months by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration obtained by interview. Results Among 1812 mother-infant dyads invited to participate, 798 met the inclusion criteria and 586 agreed to participate. The intervention group included 298 infants (154 [52.9%] boys), and the control group included 288 infants (164 [58.2%] boys). At age 6 months, mean (SD) nighttime sleep duration recorded in diaries was 9.80 (1.85) hours in the intervention group and 9.49 (2.07) hours in the control group, a difference of 19 minutes longer for the intervention group. At age 12 months, mean (SD) nighttime sleep duration based on the Brief Infant Sleep Questionnaire was 8.43 (1.35) hours in the intervention group and 8.52 (1.35) hours in the control group, a difference of 5 minutes shorter for the intervention group. At age 24 months, compared with information from the interview, actigraphy records showed that children in the intervention group stayed awake at night without signalizing for a mean (SD) of 0.52 (2.52) hours, whereas children in the control group stayed awake at night without signalizing for a mean (SD) of 0.23 (2.43) hours. There were no statistically significant difference between groups in any of the sleep parameters investigated. Conclusions and Relevance This randomized clinical trial found that the educational intervention did not achieve longer nighttime sleep duration among infants in the intervention group. Trial Registration ClinicalTrials.gov identifier: NCT02788630.
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Affiliation(s)
- Iná S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bianca Del-Ponte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Camila S. Halal
- Nossa Senhora da Conceição Children’s Hospital, Brazilian Ministry of Health, Porto Alegre, Brazil
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Departmento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Suélen Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Pedro R. Curi Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Diego G. Bassani
- Department of Paediatrics, The Hospital for Sick Children, Research Institute, University of Toronto, Toronto, Ontario, Canada
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Camerota M, Tully KP, Grimes M, Gueron-Sela N, Propper CB. Assessment of infant sleep: how well do multiple methods compare? Sleep 2019; 41:5067292. [PMID: 30085305 DOI: 10.1093/sleep/zsy146] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
The current study compares sleep variables obtained from videosomnography, actigraphy, and sleep diaries, three of the most common sleep assessment methods used in infant sleep studies. Using a sample of 90 African American 3-month olds, we compare correlations and discrepancies for seven sleep variables across each of the three pairs of assessment methods for one night of a week-long sleep study. These seven variables are indicative of sleep schedule (e.g. sleep onset time, rise time), duration (e.g. sleep period, sleep time, wake time), and fragmentation (e.g. night wakings, longest sleep period). We find that across all sleep assessment methods, correlations are highest for variables indicative of sleep schedule, and lowest for variables indicative of sleep fragmentation. Comparing the magnitude and significance of the discrepancies, we find that actigraphy and sleep diaries significantly overestimate sleep period duration and underestimate the number of night waking episodes, compared with videosomnography. Actigraphy and sleep diaries were more concordant with one another than with videosomnography. Epoch-by-epoch analyses indicated that actigraphy had low sensitivity to detect wakefulness, compared with videosomnography. Contrary to our hypothesis, the discrepancies between sleep assessment methods did not vary widely based on infant sleep location (own room vs. parent's room) or sleep surface (own bed vs. parent's bed). Limitations and implications of these findings for future research are discussed.
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Affiliation(s)
- Marie Camerota
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristin P Tully
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melissa Grimes
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Noa Gueron-Sela
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Cathi B Propper
- Center for Developmental Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Camerota M, Propper CB, Teti DM. Intrinsic and extrinsic factors predicting infant sleep: Moving beyond main effects. DEVELOPMENTAL REVIEW 2019. [DOI: 10.1016/j.dr.2019.100871] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mohr C, Gross-Hemmi MH, Meyer AH, Wilhelm FH, Schneider S. Temporal Patterns of Infant Regulatory Behaviors in Relation to Maternal Mood and Soothing Strategies. Child Psychiatry Hum Dev 2019; 50:566-579. [PMID: 30710313 DOI: 10.1007/s10578-018-00862-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4-44 weeks) by the Baby's Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes-above and beyond known relationships with overall levels of crying/fussing and sleeping-might play out on the temporal dimension of infant regulatory behaviors.
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Affiliation(s)
- Cornelia Mohr
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany.
| | - Mirja H Gross-Hemmi
- Swiss Etiological Study of Adjustment and Mental Health, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany
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Abstract
PROBLEM Sleep has historically been defined by adult standards that fail to recognize the dynamic physiologic process in the first year of life. ELIGIBILITY CRITERIA A literature review and concept analysis were conducted to examine what is known about sleep in infancy. Studies were included if sleep was objectively measured and healthy infants 0 to 12 months old were the focus of the study. SAMPLE Of 647 records identified, 348 were assessed for eligibility and 20 studies were included in the review of the literature. RESULTS Sleep in infancy is a time of evolving sleep architecture, sleep consolidation, and extensive neural activity resulting in neurodevelopment. CONCLUSIONS It is imperative to recognize the critical role of sleep for optimal infant neurodevelopment on the part of healthcare providers and society at large. IMPLICATIONS Efforts should be made to protect sleep periods in both healthy and hospitalized infants. The proposed definition has the potential to improve the care of healthy and hospitalized infants by preserving and promoting neurodevelopment.
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Affiliation(s)
- Andrea N Shimko
- Johns Hopkins All Children's Hospital, St. Petersburg, Fl, United States of America.
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31
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Hoyt CR, Van AN, Ortega M, Koller JM, Everett EA, Nguyen AL, Lang CE, Schlaggar BL, Dosenbach NUF. Detection of Pediatric Upper Extremity Motor Activity and Deficits With Accelerometry. JAMA Netw Open 2019; 2:e192970. [PMID: 31026032 PMCID: PMC6487720 DOI: 10.1001/jamanetworkopen.2019.2970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Affordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior. OBJECTIVE To develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits. DESIGN, SETTING, AND PARTICIPANTS Children aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort. EXPOSURES Bilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments. MAIN OUTCOMES AND MEASURES To characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements. RESULTS A total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]). CONCLUSIONS AND RELEVANCE Bilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.
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Affiliation(s)
- Catherine R. Hoyt
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Andrew N. Van
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Elyse A. Everett
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Annie L. Nguyen
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Catherine E. Lang
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bradley L. Schlaggar
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Anatomy and Neurobiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Biomedical Engineering, Washington University School of Medicine in St Louis, St Louis, Missouri
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Kennedy SH, Victora CG, Craik R, Ash S, Barros FC, Barsosio HC, Berkley JA, Carvalho M, Fernandes M, Cheikh Ismail L, Lambert A, Lindgren CM, McGready R, Munim S, Nellåker C, Noble JA, Norris SA, Nosten F, Ohuma EO, Papageorghiou AT, Stein A, Stones W, Tshivuila-Matala COO, Staines Urias E, Vatish M, Wulff K, Zainab G, Zondervan KT, Uauy R, Bhutta ZA, Villar J. Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21 st Newborn Case-Control Study protocol. Gates Open Res 2019; 2:49. [PMID: 31172050 PMCID: PMC6545521 DOI: 10.12688/gatesopenres.12869.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: INTERBIO-21
st is Phase II of the INTERGROWTH-21
st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21
st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment.
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Affiliation(s)
- Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Stephen Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Ludwig Institute, University of Oxford, Oxford, UK
| | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Hellen C Barsosio
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Michelle Fernandes
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
| | - Leila Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Shama Munim
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christoffer Nellåker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Shane A Norris
- SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - William Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.,Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Chrystelle O O Tshivuila-Matala
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Health, Nutrition & Population Global Practice, World Bank Group, Washington, DC, USA
| | - Eleonora Staines Urias
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ricardo Uauy
- Division of Paediatrics, Pontifical Universidad Catolica de Chile, Santiago, Chile.,Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
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33
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Kennedy SH, Victora CG, Craik R, Ash S, Barros FC, Barsosio HC, Berkley JA, Carvalho M, Fernandes M, Cheikh Ismail L, Lambert A, Lindgren CM, McGready R, Munim S, Nellåker C, Noble JA, Norris SA, Nosten F, Ohuma EO, Papageorghiou AT, Stein A, Stones W, Tshivuila-Matala COO, Staines Urias E, Vatish M, Wulff K, Zainab G, Zondervan KT, Uauy R, Bhutta ZA, Villar J. Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21 st Newborn Case-Control Study protocol. Gates Open Res 2019. [PMID: 31172050 DOI: 10.12688/gatesopenres.12869.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: INTERBIO-21 st is Phase II of the INTERGROWTH-21 st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21 st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment.
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Affiliation(s)
- Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Stephen Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Ludwig Institute, University of Oxford, Oxford, UK
| | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Hellen C Barsosio
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Michelle Fernandes
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
| | - Leila Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Shama Munim
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christoffer Nellåker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Shane A Norris
- SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - William Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.,Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Chrystelle O O Tshivuila-Matala
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Health, Nutrition & Population Global Practice, World Bank Group, Washington, DC, USA
| | - Eleonora Staines Urias
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ricardo Uauy
- Division of Paediatrics, Pontifical Universidad Catolica de Chile, Santiago, Chile.,Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
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34
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Tikotzky L, Volkovich E. Infant nocturnal wakefulness: a longitudinal study comparing three sleep assessment methods. Sleep 2018; 42:5115272. [DOI: 10.1093/sleep/zsy191] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Volkovich
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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35
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Sgandurra G, Beani E, Giampietri M, Rizzi R, Cioni G. Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol. BMC Pediatr 2018; 18:295. [PMID: 30185165 PMCID: PMC6126039 DOI: 10.1186/s12887-018-1264-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project ( www.caretoy.eu ), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R). This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention. METHODS/DESIGN This RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3. DISCUSSION This study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology. TRIAL REGISTRATION NCT03211533 and NCT03234959 ( www.clinicaltrials.gov ).
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Affiliation(s)
- Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital “Santa Chiara”, Via Roma 67, 56126 Pisa, Italy
| | - Riccardo Rizzi
- Neuroscience Center of Excellence and Neonatal Intensive Care Unit, “A. Meyer” University Children’s Hospital, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
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36
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Lan HY, Yang L, Hsieh KH, Yin T, Chang YC, Liaw JJ. Effects of a supportive care bundle on sleep variables of preterm infants during hospitalization. Res Nurs Health 2018; 41:281-291. [PMID: 29675875 DOI: 10.1002/nur.21865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 01/18/2023]
Abstract
Sleep is important for preterm infants' brain development, but they are frequently exposed to painful procedures in the neonatal intensive care unit (NICU) that disturb their sleep cycle and affect their growth. The purpose of this study was to examine the prolonged effects of a supportive care bundle (modulation of the infants' states, non-nutritive sucking, facilitated tucking, and oral sucrose feeding) on preterm infants' sleep variables (sleep efficiency, total sleep time, sleep latency, and frequency of wake bouts) during hospitalization. The team recruited 65 preterm infants (gestational age at birth 28-36 weeks, average birth weight 1,652 g) from a Level III NICU at a medical center in Taiwan. Infants were randomly assigned to one of two treatment conditions to be administered while receiving intrusive procedures: (1) control condition (usual care, including routine procedures, positioning, and gentle touch); or (2) intervention condition in which the supportive care bundle was added to usual care. Sleep variables were measured using actigraphy for a baseline of three continuous days on the 6th to 8th days after birth and again for 3 continuous days when infants weighed ≧1,950 g. Two forms of generalized estimating equation analyses with control of significant covariates were used for data analysis. The supportive care bundle not only significantly increased sleep efficiency and total sleep time but also significantly decreased duration of sleep latency and frequency of wake bouts. These results provide evidence to support the incorporation of the supportive care bundle into NICU clinical practice during intrusive procedures.
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Affiliation(s)
- Hsiang-Yun Lan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Luke Yang
- Department of Social Work, Hsuan Chuang University, Taipei, Taiwan
| | - Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan
| | - Ti Yin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Song-Shan Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
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37
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Thurman SM, Wasylyshyn N, Roy H, Lieberman G, Garcia JO, Asturias A, Okafor GN, Elliott JC, Giesbrecht B, Grafton ST, Mednick SC, Vettel JM. Individual differences in compliance and agreement for sleep logs and wrist actigraphy: A longitudinal study of naturalistic sleep in healthy adults. PLoS One 2018; 13:e0191883. [PMID: 29377925 PMCID: PMC5788380 DOI: 10.1371/journal.pone.0191883] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/12/2018] [Indexed: 12/20/2022] Open
Abstract
There is extensive laboratory research studying the effects of acute sleep deprivation on biological and cognitive functions, yet much less is known about naturalistic patterns of sleep loss and the potential impact on daily or weekly functioning of an individual. Longitudinal studies are needed to advance our understanding of relationships between naturalistic sleep and fluctuations in human health and performance, but it is first necessary to understand the efficacy of current tools for long-term sleep monitoring. The present study used wrist actigraphy and sleep log diaries to obtain daily measurements of sleep from 30 healthy adults for up to 16 consecutive weeks. We used non-parametric Bland-Altman analysis and correlation coefficients to calculate agreement between subjectively and objectively measured variables including sleep onset time, sleep offset time, sleep onset latency, number of awakenings, the amount of wake time after sleep onset, and total sleep time. We also examined compliance data on the submission of daily sleep logs according to the experimental protocol. Overall, we found strong agreement for sleep onset and sleep offset times, but relatively poor agreement for variables related to wakefulness including sleep onset latency, awakenings, and wake after sleep onset. Compliance tended to decrease significantly over time according to a linear function, but there were substantial individual differences in overall compliance rates. There were also individual differences in agreement that could be explained, in part, by differences in compliance. Individuals who were consistently more compliant over time also tended to show the best agreement and lower scores on behavioral avoidance scale (BIS). Our results provide evidence for convergent validity in measuring sleep onset and sleep offset with wrist actigraphy and sleep logs, and we conclude by proposing an analysis method to mitigate the impact of non-compliance and measurement errors when the two methods provide discrepant estimates.
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Affiliation(s)
- Steven M. Thurman
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
| | - Nick Wasylyshyn
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
| | - Heather Roy
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
| | - Gregory Lieberman
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
| | - Javier O. Garcia
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
- University of Pennsylvania, Department of Bioengineering, Philadelphia, Pennsylvania, United States of America
| | - Alex Asturias
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
| | - Gold N. Okafor
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
| | - James C. Elliott
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
| | - Barry Giesbrecht
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
| | - Scott T. Grafton
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
| | - Sara C. Mednick
- University of California, Irvine, Department of Cognitive Science, Irvine, California, United States of America
| | - Jean M. Vettel
- U.S. Army Research Laboratory, Human Research & Engineering Directorate, Aberdeen Proving Ground, Maryland, United States of America
- University of Pennsylvania, Department of Bioengineering, Philadelphia, Pennsylvania, United States of America
- University of California, Santa Barbara, Department of Psychological & Brain Sciences, Santa Barbara, California, United States of America
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38
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Dias CC, Figueiredo B, Rocha M, Field T. Reference values and changes in infant sleep-wake behaviour during the first 12 months of life: a systematic review. J Sleep Res 2018; 27:e12654. [DOI: 10.1111/jsr.12654] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/04/2017] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Magda Rocha
- School of Psychology; University of Minho; Braga Portugal
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39
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Schwichtenberg AJ, Choe J, Kellerman A, Abel EA, Delp EJ. Pediatric Videosomnography: Can Signal/Video Processing Distinguish Sleep and Wake States? Front Pediatr 2018; 6:158. [PMID: 29974042 PMCID: PMC6020776 DOI: 10.3389/fped.2018.00158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
The term videosomnography captures a range of video-based methods used to record and subsequently score sleep behaviors (most commonly sleep vs. wake states). Until recently, the time consuming nature of behavioral videosomnography coding has limited its clinical and research applications. However, with recent technological advancements, the use of auto-videosomnography techniques may be a practical and valuable extension of behavioral videosomnography coding. To test an auto-videosomnography system within a pediatric sample, we processed 30 videos of infant/toddler sleep using a series of signal/video-processing techniques. The resulting auto-videosomnography system provided minute-by-minute sleep vs. wake estimates, which were then compared to behaviorally coded videosomnography and actigraphy. Minute-by-minute estimates demonstrated moderate agreement across compared methods (auto-videosomnography with behavioral videosomnography, Cohen's kappa = 0.46; with actigraphy = 0.41). Additionally, auto-videosomnography agreements exhibited high sensitivity for sleep but only about half of the wake minutes were correctly identified. For sleep timing (sleep onset and morning rise time), behavioral videosomnography and auto-videosomnography demonstrated strong agreement. However, nighttime waking agreements were poor across both behavioral videosomnography and actigraphy comparisons. Overall, this study provides preliminary support for the use of an auto-videosomnography system to index sleep onset and morning rise time only, which may have potential telemedicine implications. With replication, auto-videosomnography may be useful for researchers and clinicians as a minimally invasive sleep timing assessment method.
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Affiliation(s)
- A J Schwichtenberg
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Jeehyun Choe
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Ashleigh Kellerman
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Emily A Abel
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Edward J Delp
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
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40
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Aktaruzzaman M, Rivolta MW, Karmacharya R, Scarabottolo N, Pugnetti L, Garegnani M, Bovi G, Scalera G, Ferrarin M, Sassi R. Performance comparison between wrist and chest actigraphy in combination with heart rate variability for sleep classification. Comput Biol Med 2017; 89:212-221. [DOI: 10.1016/j.compbiomed.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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41
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Tarullo AR, Isler JR, Condon C, Violaris K, Balsam PD, Fifer WP. Neonatal eyelid conditioning during sleep. Dev Psychobiol 2017; 58:875-882. [PMID: 27753460 DOI: 10.1002/dev.21424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/18/2016] [Indexed: 01/09/2023]
Abstract
Using an eyelid conditioning paradigm modeled after that developed by Little, Lipsitt, and Rovee-Collier (1984), Fifer et al. (2010) demonstrated that newborn infants learn during sleep. This study examined the role of sleep state in neonatal learning. We recorded electroencephalogram (EEG), respiratory, and cardiovascular activity from sleeping full term newborn infants during delay eyelid conditioning. In the experimental group (n = 21), a tone was paired with an air puff to the eye. Consistent with Fifer et al. (2010), newborn infants reliably learned during sleep. The experimental group more than doubled EMR rates to a tone alone, while a control group (n = 17) presented with unpaired tones and puffs maintained low EMR rates. Infant learners were more likely to produce a conditioned EMR during quiet sleep compared to active sleep. Understanding the influence of sleep state on conditioned responses will inform the potential use of eyelid conditioning for early screening.
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Affiliation(s)
- Amanda R Tarullo
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts.
| | - Joseph R Isler
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Carmen Condon
- New York State Psychiatric Institute, New York, New York
| | - Kimon Violaris
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Peter D Balsam
- Department of Psychiatry, Columbia University Medical Center, New York, New York.,Department of Psychology, Barnard College, Columbia University, New York, New York
| | - William P Fifer
- Department of Pediatrics, Columbia University Medical Center, New York, New York.,New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University Medical Center, New York, New York
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42
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Lan HY, Yin T, Chen JL, Chang YC, Liaw JJ. Factors Associated With Preterm Infants’ Circadian Sleep/Wake Patterns at the Hospital. Clin Nurs Res 2017; 28:456-472. [DOI: 10.1177/1054773817724960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants’ circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants’ total sleep time ( B = 41.828, p < .01) and percentage of sleep time ( B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants’ sleep problems, signaling the need to provide individualized support to maintain these infants’ sleep quality during their early life.
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Affiliation(s)
- Hsiang-Yun Lan
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | - Ti Yin
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
- Nursing Department, Song-Shan Branch,Tri-Service General Hospital, Taipei City, Taiwan (R.O.C.)
| | | | | | - Jen-Jiuan Liaw
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
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43
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Exclusive breastfeeding at three months and infant sleep-wake behaviors at two weeks, three and six months. Infant Behav Dev 2017; 49:62-69. [PMID: 28735066 DOI: 10.1016/j.infbeh.2017.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/22/2022]
Abstract
This study assessed infant sleep-wake behavior at two weeks, three and six months as function of feeding method at three months (exclusively breastfed, partially breastfed, and exclusively formula fed infants). Mothers of 163 first-born, full-term, normal birth weight, healthy infants completed socio-demographic, depression, anxiety, and infant sleep-wake behavior measures. No effects were found for sleep arrangements, depression or anxiety, on feeding methods and sleep-wake behavior at three months. At two weeks exclusively breastfed infants at three months spent more hours sleeping and less hours awake during the 24-h period than partially breastfed infants. At three months, exclusively breastfed infants had a shorter of the longest sleep period at night than exclusively formula fed infants. At six months, exclusively breastfed infants at three months spent more hours awake at night than partially breastfed infants, awake more at night than exclusively formula fed infants, and had a shorter sleep period at night than partially breastfed and exclusively formula fed infants. This study showed differences in sleep-wake behaviors at two weeks, three and six months, when exclusively breastfed infants are compared with partially breastfed and exclusively formula fed infants at three months, while no effects were found for sleep arrangements, depression or anxiety.
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44
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Infant sleep problems and interventions: A review. Infant Behav Dev 2017; 47:40-53. [DOI: 10.1016/j.infbeh.2017.02.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/18/2017] [Accepted: 02/21/2017] [Indexed: 01/04/2023]
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Bueno C, Menna-Barreto L. Environmental factors influencing biological rhythms in newborns: From neonatal intensive care units to home. ACTA ACUST UNITED AC 2017; 9:295-300. [PMID: 28154744 PMCID: PMC5279954 DOI: 10.1016/j.slsci.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022]
Abstract
Photic and non-photic environmental factors are suggested to modulate the development of circadian rhythms in infants. Our aim is to evaluate the development of biological rhythms (circadian or ultradian) in newborns in transition from Neonatal Intensive Care Units (NICU) to home and along the first 6 months of life, to identify masking and entraining environment factors along development. Ten newborns were evaluated in their last week inside the NICU and in the first week after being delivered home; 6 babies were also followed until 6 months of corrected age. Activity, recorded with actimeters, wrist temperature and observed sleep and feeding behavior were recorded continuously along their last week inside the NICU and in the first week at home and also until 6 months of corrected age for the subjects who remained in the study. Sleep/wake and activity/rest cycle showed ultradian patterns and the sleep/wake was strongly influenced by the 3 h feeding schedule inside the NICU, while wrist temperature showed a circadian pattern that seemed no to be affected by environmental cycles. A circadian rhythm emerges for sleep/wake behavior in the first week at home, whereas the 3 h period vanishes. Both activity/rest and wrist temperature presented a sudden increase in the contribution of the circadian component immediately after babies were delivered home, also suggesting a masking effect of the NICU environment. We found a positive correlation of postconceptional age and the increase in the daily component of activity and temperature along the following 6 months, while feeding behavior became arrhythmic.
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Affiliation(s)
- Clarissa Bueno
- Departmento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas, Universidade de São Paulo, Cidade Universitária, Av. Lineu Prestes, 1524, Butantã, Cep:05508-900 São Paulo, SP, Brazil
- Corresponding author. Present address: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr Enéas de Carvalho Aguiar, 255. Cerqueira César, Cep:05403-000 São Paulo, SP, Brazil.
| | - Luiz Menna-Barreto
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Av. Arlindo Béttio, 1000. Ermelino Matarazzo, Cep:03828-000 São Paulo, SP, Brazil
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Santos IS, Bassani DG, Matijasevich A, Halal CS, Del-Ponte B, da Cruz SH, Anselmi L, Albernaz E, Fernandes M, Tovo-Rodrigues L, Silveira MF, Hallal PC. Infant sleep hygiene counseling (sleep trial): protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:307. [PMID: 27590170 PMCID: PMC5010682 DOI: 10.1186/s12888-016-1016-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep problems in childhood have been found to be associated with memory and learning impairments, irritability, difficulties in mood modulation, attention and behavioral problems, hyperactivity and impulsivity. Short sleep duration has been found to be associated with overweight and obesity in childhood. This paper describes the protocol of a behavioral intervention planned to promote healthier sleep in infants. METHODS The study is a 1:1 parallel group single-blinded randomized controlled trial enrolling a total of 552 infants at 3 months of age. The main eligibility criterion is maternal report of the infant's sleep lasting on average less than 15 h per 24 h (daytime and nighttime sleep). Following block randomization, trained fieldworkers conduct home visits of the intervention group mothers and provide standardized advice on general practices that promote infant's self-regulated sleep. A booklet with the intervention content to aid the mother in implementing the intervention was developed and is given to the mothers in the intervention arm. In the two days following the home visit the intervention mothers receive daily telephone calls for intervention reinforcement and at day 3 the fieldworkers conduct a reinforcement visit to support mothers' compliance with the intervention. The main outcome assessed is the between group difference in average nighttime self-regulated sleep duration (the maximum amount of time the child stays asleep or awake without awakening the parents), at ages 6, 12 and 24 months, evaluated by means of actigraphy, activity diary records and questionnaires. The secondary outcomes are conditional linear growth between age 3-12 and 12-24 months and neurocognitive development at ages 12 and 24 months. DISCUSSION The negative impact of inadequate and insufficient sleep on children's physical and mental health are unquestionable, as well as its impact on cognitive function, academic performance and behavior, all of these being factors to which children in low- and middle-income countries are at higher risk. Behavioral interventions targeting mothers and young children that can be delivered inexpensively and not requiring specialized training can help prevent future issues by reducing the risk to which these children are exposed. TRIAL REGISTRATION ClinicalTrial.gov NCT02788630 registered on 14 June 2016 (retrospectively registered).
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Affiliation(s)
- Ina S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Diego G. Bassani
- Centre for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alicia Matijasevich
- Department of Preventive Medicine, School of Medicine, University of Sao Paulo, São Paulo, SP Brazil
| | - Camila S. Halal
- Hospital da Criança Conceição – Ministry of Health, Porto Alegre, RS Brazil
| | - Bianca Del-Ponte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Suélen Henriques da Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Elaine Albernaz
- Department of Maternal and Child Health, Faculty of Medicine, Federal University of Pelotas, Pelotas, RS Brazil
| | - Michelle Fernandes
- Oxford Maternal and Perinatal Health Institute International Research Fellow, Nuffield Department of Obstetrics and Gynaecology, The John Radcliffe Hospital, University of Oxford, Toronto, UK ,Core Clinical Fellow in Paediatrics, Department of Paediatrics, Southampton General Hospital and Southampton University, Southampton, UK
| | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Mariangela F. Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
| | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3rd floor, 96220020 Pelotas, RS Brazil
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Infant sleep-wake behaviors at two weeks, three and six months. Infant Behav Dev 2016; 44:169-78. [PMID: 27448323 DOI: 10.1016/j.infbeh.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 11/20/2022]
Abstract
Although infant sleep-wake behavior presents several developmental changes during the first six months, literature lacks on reference values and few studies have explored the role of individual change and stability on infant sleep-wake behavior during the first six months. This study aimed (1) to describe infant sleep-wake behaviors during the 24-h period, day and night, at two weeks, three, and six months, (2) and to explore developmental changes and the role of individual change and stability on infant sleep-wake behaviors from two weeks to six months. Ninety-four primiparous mothers completed measures on infant sleep-wake behaviors at two weeks, three and six months. Significant developmental changes were found on infant sleep-wake behaviors from two weeks to six months. Two-week-old infants sleep 13.3h, spend 8.7h awake, awake 6.1 times, have 0.4h of latency to sleep, and 3.2h of longest sleep period. Three-month-old infants sleep 13.0h, spend 9.2h awake, awake 5.5 times, have 0.4h of latency to sleep, and 5.2h of longest sleep period. Six-month-old infants sleep 12.2h, spend 10.0h awake, awake 5.2 times, have 0.4h of latency to sleep, and 5.6h of longest sleep period. Significant individual change and stability were also found on infant sleep-wake behaviors from two weeks to six months. Despite significant developmental and individual changes, individual stability explains a significant amount of the variance on infant sleep-wake behaviors over the first six months of life.
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Gradisar M, Jackson K, Spurrier NJ, Gibson J, Whitham J, Williams AS, Dolby R, Kennaway DJ. Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics 2016; 137:peds.2015-1486. [PMID: 27221288 DOI: 10.1542/peds.2015-1486] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. METHODS A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment. RESULTS Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups. CONCLUSIONS Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.
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Affiliation(s)
| | | | - Nicola J Spurrier
- Public Health and Health Promotion, SA Health, South Australia, Australia
| | - Joyce Gibson
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | | | - Anne Sved Williams
- Department of Psychiatry, and Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Robyn Dolby
- Public Health and Health Promotion, SA Health, South Australia, Australia
| | - David J Kennaway
- School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia; and
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Bueno C, Menna-Barreto L. Development of sleep/wake, activity and temperature rhythms in newborns maintained in a neonatal intensive care unit and the impact of feeding schedules. Infant Behav Dev 2016; 44:21-8. [PMID: 27261553 DOI: 10.1016/j.infbeh.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Biological rhythms in infants are described as evolving from an ultradian to a circadian pattern along the first months of life. Recently, the use of actigraphy and thermistors with memory has contributed to the understanding of temporal relations of different variables along development. The aim of this study was to describe and compare the development of the rhythmic pattern of wrist temperature, activity/rest cycle, sleep/wake and feeding behavior in term and preterm newborns maintained in a neonatal intensive care unit (NICU). METHODS Nineteen healthy preterm and seven fullterm newborns had the following variables monitored continuously while they were in the NICU: activity recorded by actigraphy, wrist temperature recorded with a thermistor and observed sleep and feeding behavior recorded by the NICU staff with diaries. Subjects were divided in 3 groups according to their gestational age at birth and rhythmic parameters were compared. RESULTS A dominant daily rhythm was observed for wrist temperature since the first two weeks of life and no age relation was demonstrated. Otherwise, a daily pattern in activity/rest cycle was observed for most preterm newborns since 35 weeks of postconceptional age and was more robust in term babies. Feeding and sleep/wake data showed an almost exclusive 3h rhythm, probably related to a masking effect of feeding schedules. CONCLUSIONS We found that wrist temperature develops a daily pattern as soon as previously reported for rectal temperature, and with acrophase profile similar to adults. Moreover, we were able to find a daily rhythm in activity/rest cycle earlier than previously reported in literature. We also suggest that sleep/wake rhythm and feeding behavior follow independent developmental courses, being more suitable to masking effects.
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Affiliation(s)
- Clarissa Bueno
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of São Paulo, Brazil.
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Wang NR, Ye Y. [A prospective study of the development of nocturnal sleep patterns in infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:350-354. [PMID: 27097582 PMCID: PMC7390075 DOI: 10.7499/j.issn.1008-8830.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/14/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the development of nocturnal sleep pattern in infants. METHODS Fifty healthy full-term newborns born in Chongqing Maternal and Child Health Care Hospital were chosen for a prospective longitudinal study. A non-invasive sleep monitor, Actiwatch, was used to monitor infants' 12 sleep parameters on the 10th day, 28th day, the first Tuesday at the 2nd, 3rd, 4th, 5th, 6th, 9th and 12th month after birth, each monitoring time lasting 60 hours. All sleep parameters were analyzed by two-level mixed effect model. RESULTS Twenty-two boys and 25 girls completed the whole follow-up study. From birth to the 12th month after birth, the nocturnal sleep onset latency (NSOL) decreased by about 48% at 3 months of age and by 83% at 6 months of age. The nocturnal sleep efficiency (NSE%) increased from 66% to 87%, the nocturnal total sleep time (NTST) increased from 416 minutes to 517 minutes, and the longest nocturnal continuous sleeping time (L-NCST) increased from 197 minutes to 327 minutes. NSE%, NTST and L-NCST increased with age (P<0.01). The 3rd to 12th month ratios of NSE%, NTST and L-NCST were 86%, 84% and 72%, respectively, and the 6th to 12th month ratios of those were 97%, 91% and 94%, respectively. The nocturnal total wake time (NTWT) and longest nocturnal continuous waking times (L-NCWT) decreased with age (P<0.01). The decline speeds in the first half year were 5-6 times of those in the second half year after birth (P<0.05). NTST, nocturnal continuous sleeping ability and NSE% in boys were lower than those in girls (P<0.05). CONCLUSIONS Infantile nocturnal sleep patterns develop rapidly during the first 6 months, especially within the first 3 months after birth. Partial infantile sleep parameters are related to gender.
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Affiliation(s)
- Nian-Rong Wang
- Department of Child Health Care, Chongqing Maternal and Child Health Care Hospital, Chongqing 400013, China.
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