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Hotta M, Ueda K, Ikehara S, Tanigawa K, Nakayama H, Wada K, Kimura T, Ozono K, Sobue T, Iso H. Association between neonatal phototherapy and sleep: The Japan Environment and Children's Study. J Sleep Res 2023; 32:e13911. [PMID: 37105535 DOI: 10.1111/jsr.13911] [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: 09/26/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
This observational cohort study aimed to evaluate the association between the duration of neonatal phototherapy and sleep-and-wakefulness states at 1 month, 1.5 years, and 3 years of age. We analysed data from 77,876 infants using the Japan Environment and Children's Study, a nationwide birth cohort study. The participants were divided into three groups: no phototherapy, short phototherapy (1-24 h), and long phototherapy (>24 h). Multiple regression analysis was performed to assess the effect of phototherapy duration on infant sleep at each age after adjusting for potential risk factors. A longer duration of phototherapy was associated with a shorter sleep time over 24 h at 1 month of age (β, -0.62; SE, -0.77 to -0.47) when compared with a shorter duration of, or no, phototherapy, following the adjustment of confounding factors. Contrastingly, the short duration group, when compared with the no phototherapy group, was associated with later sleep onset (β, 0.04; SE, 0.00-0.08) and later sleep offset (β, 0.05; SE, 0.01-0.09) at 1.5 years of age. We concluded that the duration of phototherapy may be transiently associated with sleep duration in infants, as emphasised by the shortening of the total sleep time per 24 h at 1 month of age.
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Affiliation(s)
- Masashi Hotta
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kimiko Ueda
- Maternal & Child Health Information Center, Osaka Women's and Children's Hospital, Japan
| | - Satoyo Ikehara
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Kanami Tanigawa
- Maternal & Child Health Information Center, Osaka Women's and Children's Hospital, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Hirofumi Nakayama
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
| | - Hiroyasu Iso
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
- Osaka Regional Center for Japan Environment and Children's Study (JECS), Osaka University, Suita, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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2
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Asaka Y, Mitani Y, Ohta H, Nakazawa T, Fukutomi R, Kobayashi K, Kumagai M, Shinohara H, Yoshida M, Ando A, Yoshimura Y, Nakagawa M, Oishi Y, Mizushima M, Adachi H, Kaneshi Y, Morioka K, Seto Y, Shimabukuro R, Hirata M, Ikeda T, Ozawa M, Takeshima M, Manabe A, Takahashi T, Mishima K, Kikuchi M, Yoda H, Kusakawa I, Cho K. Preterm toddlers have low nighttime sleep quality and high daytime activity. Sci Rep 2022; 12:20032. [PMID: 36414705 PMCID: PMC9681750 DOI: 10.1038/s41598-022-24338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.
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Affiliation(s)
- Yoko Asaka
- grid.260026.00000 0004 0372 555XDepartment of Maternal and Child Health Nursing, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, 514-8507 Japan
| | - Yusuke Mitani
- grid.9707.90000 0001 2308 3329Department of Pediatrics, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Hidenobu Ohta
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan ,grid.416859.70000 0000 9832 2227Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi-Cho, Kodaira, Tokyo 187-8553 Japan ,Department of Psychiatry, Asai Hospital, 38-1 Togane, Chiba, 283-0062 Japan ,grid.251924.90000 0001 0725 8504Department of Occupational Therapy, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Takayo Nakazawa
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Rika Fukutomi
- grid.419588.90000 0001 0318 6320Department of Pediatric Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044 Japan
| | - Kyoko Kobayashi
- grid.419588.90000 0001 0318 6320Department of Pediatric Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044 Japan
| | - Mayuko Kumagai
- grid.251924.90000 0001 0725 8504Department of Nursing, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Hitomi Shinohara
- grid.462295.e0000 0004 0370 9568Graduate School of Nursing, Hyogo University, 2301 Shinzaike, Hiraoka-Cho, Kakogawa, 675-0195 Japan
| | - Michiko Yoshida
- grid.39158.360000 0001 2173 7691Department of Nursing, Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-Ku, Sapporo, 060-0812 Japan
| | - Akiko Ando
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Yuko Yoshimura
- grid.9707.90000 0001 2308 3329Institute of Human and Social Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, 921-1192 Japan ,grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Machiko Nakagawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.452874.80000 0004 1771 2506Department of Neonatology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541 Japan
| | - Yoshihisa Oishi
- grid.414929.30000 0004 1763 7921Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935 Japan
| | - Masato Mizushima
- Department of Neonatology, Sapporo City Hospital, N11, W13, Chuo-Ku, Sapporo, 060-8604 Japan
| | - Hiroyuki Adachi
- grid.251924.90000 0001 0725 8504Department of Pediatrics, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543 Japan
| | - Yosuke Kaneshi
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Keita Morioka
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Yoshitaka Seto
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Rinshu Shimabukuro
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.63906.3a0000 0004 0377 2305Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Ohkura, Setagaya-Ku, Tokyo, 157-8535 Japan
| | - Michio Hirata
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.411827.90000 0001 2230 656XDepartment of Child Studies, Faculty of Human Sciences and Design, Japan Women’s University, 2-8-1 Mejirodai, Bunkyo-Ku, Tokyo, 112-8681 Japan
| | - Takashi Ikeda
- grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Miwa Ozawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Masahiro Takeshima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Atsushi Manabe
- grid.39158.360000 0001 2173 7691Department of Pediatrics, Hokkaido University Graduate School of Medicine, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Tsutomu Takahashi
- grid.251924.90000 0001 0725 8504Department of Pediatrics, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543 Japan
| | - Kazuo Mishima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Mitsuru Kikuchi
- grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan ,grid.9707.90000 0001 2308 3329Department of Psychiatry and Neurobiology, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Hitoshi Yoda
- grid.452874.80000 0004 1771 2506Department of Neonatology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541 Japan
| | - Isao Kusakawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Kazutoshi Cho
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
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Trickett J, Hill C, Austin T, Johnson S. The Impact of Preterm Birth on Sleep through Infancy, Childhood and Adolescence and Its Implications. CHILDREN 2022; 9:children9050626. [PMID: 35626803 PMCID: PMC9139673 DOI: 10.3390/children9050626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
There is emergent literature on the relationship between the development of sleep-wake cycles, sleep architecture, and sleep duration during the neonatal period on neurodevelopmental outcomes among children born preterm. There is also a growing literature on techniques to assess sleep staging in preterm neonates using either EEG methods or heart and respiration rate. Upon discharge from hospital, sleep in children born preterm has been assessed using parent report, actigraphy, and polysomnography. This review describes the ontogeny and measurement of sleep in the neonatal period, the current evidence on the impact of preterm birth on sleep both in the NICU and in childhood and adolescence, and the interaction between sleep, cognition, and social-emotional outcomes in this population.
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Affiliation(s)
- Jayne Trickett
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK
- Correspondence:
| | - Catherine Hill
- School of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- Department of Sleep Medicine, Southampton Children’s Hospital, Southampton SO17 1BJ, UK
| | - Topun Austin
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK;
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
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Do preterm babies sleep differently than their peers? Sleep characteristics and their associations with maternal depression and parenting stress. Sleep Med 2022; 90:109-116. [DOI: 10.1016/j.sleep.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/21/2022]
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Lupini F, Leichman ES, Lee C, Mindell JA. Sleep patterns, problems, and ecology in young children born preterm and full-term and their mothers. Sleep Med 2021; 81:443-450. [PMID: 33839374 DOI: 10.1016/j.sleep.2021.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/28/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies of sleep patterns and problems in preterm infants compared to full-term infants have yielded mixed results, with little known about sleep ecology. The aims of this study were to compare sleep patterns, sleep problems, and sleep ecology across developmental stages (birth to 36 months) in preterm (3 or more weeks early) infants and toddlers to those born full-term, in addition to their mothers' sleep. METHODS Mothers of 834 young children in Brazil (ages 0-35.9 months), half preterm and half full-term (matched for sex and chronological age), completed the Brief Infant Sleep Questionnaire and the Pittsburgh Sleep Quality Index. RESULTS Across the entire sample, preterm and full-term infants were similar for most sleep parameters, including sleep onset latency, number and duration of night awakenings, and sleep duration, as well as sleep ecology parameters, including falling asleep independently and sleep location. However, preterm infants were more likely to be held to initiate sleep, given a bottle to resume sleep after waking, and less likely to be breastfed to resume sleep after waking. Mothers of preterm infants, however, were more likely to report a parent-perceived sleep problem, although maternal-perceived confidence in managing child sleep and bedtime difficulty were similar. Finally, maternal sleep parameters were similar between groups. CONCLUSIONS Overall, these results indicate that sleep patterns, sleep problems, and sleep ecology among preterm infants and toddlers and their mothers are largely similar to those of full-term infants and toddlers and their mothers, even within the first few months.
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Affiliation(s)
| | | | | | - Jodi A Mindell
- Saint Joseph's University, United States; Children's Hospital of Philadelphia, United States.
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6
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Guyer C, Huber R, Fontijn J, Bucher HU, Nicolai H, Werner H, Molinari L, Latal B, Jenni OG. Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term infants. Early Hum Dev 2015; 91:37-42. [PMID: 25460255 DOI: 10.1016/j.earlhumdev.2014.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies show contradictory results about the emergence of 24-h rhythms and the influence of external time cues on sleep-wake behavior in preterm compared to term infants. AIMS To examine whether very preterm infants (<32 weeks of gestational age) differ in their emergence of the 24-h sleep-wake rhythm at 5, 11 and 25 weeks corrected age compared to term infants and whether cycled light conditions during neonatal intermediate care affects postnatal 24-h sleep-wake rhythms in preterm infants. STUDY DESIGN Prospective cohort study with nested interventional trial. SUBJECTS 34 preterm and 14 control term infants were studied. During neonatal hospitalization, preterm infants were randomly assigned to cycled light [7 am-7 pm lights on, 7 pm-7 am lights off, n=17] or dim light condition [lights off whenever the child is asleep, n=17]. OUTCOME MEASURES Sleep and activity behavior recorded by parental diary and actigraphy at 5, 11 and 25 weeks corrected age. RESULTS Sleep at nighttime and the longest consolidated sleep period between 12 pm-6 am was longer (mixed model analysis, factor group: p=0.02, resp. p=0.01) and activity at nighttime was lower (p=0.005) at all ages in preterm compared to term infants. Cycled light exposed preterm infants showed the longest nighttime sleep duration. Dim light exposed preterm infants were the least active. CONCLUSIONS Preterm infants show an earlier emergence of the 24-h sleep-wake rhythm compared to term infants. Thus, the length of exposure to external time cues such as light may be important for the maturation of infant sleep-wake rhythms. Trial registry number: This trial has been registered at www.clinicaltrials.gov (identifier NCT01513226).
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Affiliation(s)
- Caroline Guyer
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Reto Huber
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Jehudith Fontijn
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Hans Ulrich Bucher
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Heide Nicolai
- Clinic Neonatology, University Hospital Zürich, CH-8091 Zürich, Switzerland
| | - Helene Werner
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Luciano Molinari
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Beatrice Latal
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland
| | - Oskar G Jenni
- Child Development Center, Department of Pediatrics, University Children's Hospital Zürich, CH-8032 Zürich, Switzerland; Children's Research Center (CRC), University Children's Hospital Zürich, CH-8032 Zürich, Switzerland.
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Dorn F, Wirth L, Gorbey S, Wege M, Zemlin M, Maier RF, Lemmer B. Influence of acoustic stimulation on the circadian and ultradian rhythm of premature infants. Chronobiol Int 2014; 31:1062-74. [PMID: 25133792 DOI: 10.3109/07420528.2014.948183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED The aim of the present study was to evaluate the development of the circadian rhythm of the salivary cortisol in premature infants and its correlation with the onset of the sleep-activity behavior pattern during the first 3 weeks of life under controlled light:dark conditions. Furthermore, we investigated the influence of acoustic stimulation by audiotaped lullabies or the maternal voice on the cortisol values and long-term sleep-activity patterns. The study was a block-randomized, prospective clinical trial with a study population of 62 preterm neonates (30<37 gestational age). We compared two study groups who listened either to music or to the maternal voice (music: N=20; maternal voice: N=20) with a matched control group (N=22). The acoustic stimulation took place every evening between 20:00 and 21:00 h for 30 min over a period of 2 weeks. The cortisol values and activity-rest behavior of the neonates were determined during the first 3 weeks of life on the 1st, 7th and 14th day. Actigraphic monitoring was used to record the activity pattern continuously over 24 h and a validated algorithm for neonates was used to estimate sleep and wakefulness. The saliva samples were obtained 10 min before and 10 min after the acoustic interventions for the study groups. Additionally, saliva samples were obtained from the control group seven times over a 24-h period (20:00, 21:00, 01:00, 05:00, 08:00, 13:00 and 17:00 h). The cortisol data were analyzed by fast Fourier transformation to assess periodic characteristics and frequencies. Hierarchical linear modeling was further performed for the statistical analysis. RESULTS The cortisol rhythm analysis indicated a circadian rhythm pattern for only one premature infant, all others of the neonates showed no circadian or ultradian rhythm in cortisol. Cortisol level of the premature neonates was significantly higher during the first day of the study period at night-time (median: 17.1 nmol/L, IQR=9.7-24.4 nmol/L) than on days 7 (median: 9.6 nmol/L, IQR=4.7-14.6 nmol/L; Tukey-HSD, z=4.12, p<0.001) and 14 (IQR=5.8-13.7 nmol/L; Tukey-HSD, z=2.89, p<0.05). No significant effect of acoustic stimulation was observed on the cortisol concentration and sleep-wake behavior. The activity-sleep rhythm of preterm neonates was dominated by ultradian rhythm patterns with a prominent period length of 4 h (30.5%). Activity frequencies of neonates were also significantly higher overnight on the first study day (mean: 329±185.1 U) than of night seven (mean: 260.2±132.4 U; Tukey-HSD, z=2.50, p<0.05). Quiet-activity patterns increased, whereas high-activity patterns decreased during the observation period. Average sleep time increased significantly during the study time from day 1 to day 7 (Tukey-HSD, z=2.51, p<0.05). In conclusion, premature infants showed higher cortisol levels - without a circadian rhythmicity - and higher activity frequencies in the first days after birth which may reflect an adaptation process of neonates after birth. Cortisol concentrations and the activity patterns were not influenced by music interventions.
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Affiliation(s)
- Franziska Dorn
- Department of Pediatrics, Philipps-University Marburg , Marburg , Germany and
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8
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Brooks E, Canal MM. Development of circadian rhythms: role of postnatal light environment. Neurosci Biobehav Rev 2013; 37:551-60. [PMID: 23454636 DOI: 10.1016/j.neubiorev.2013.02.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/31/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
Mammals are born with an immature circadian system, which completes its development postnatally. Evidence suggests that the environment experienced by a newborn will impact and shape its development, which will have future consequences at the levels of circadian system function, circadian behaviour and physiology, and potentially, the animal's long-term health and welfare. Here we review the various stages in postnatal development of the circadian system, and discuss the data available on the long-term effects of early environment, in particular light environment, on the animal's brain, physiology and behaviour.
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Affiliation(s)
- Elisabeth Brooks
- University of Manchester, Faculty of Life Sciences, AV Hill Building, Oxford Road, Manchester M13 9PT, UK
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9
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Guyer C, Huber R, Fontijn J, Bucher HU, Nicolai H, Werner H, Molinari L, Latal B, Jenni OG. Cycled light exposure reduces fussing and crying in very preterm infants. Pediatrics 2012; 130:e145-51. [PMID: 22689866 DOI: 10.1542/peds.2011-2671] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine whether cycled lighting (CL) conditions during neonatal care in very preterm infants (<32 weeks' gestational age [GA]) decrease crying and fussing behavior, improve the consolidation of sleep, and influence activity behavior at 5 and 11 weeks' postterm corrected age (CA) compared with preterm infants cared for in dim lighting (DL) conditions. METHODS Thirty-seven preterm infants were randomly assigned to CL (7 am-7 pm lights on, 7 pm-7 am lights off [n = 17; mean GA: 30.6 ± 0.95 weeks; 9 girls]) or DL (lights off whenever the child is asleep [n = 20; GA: 29.5 ± 2.1 weeks; 8 girls]) conditions. Sleeping, crying, and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks' CA. RESULTS A significant reduction of fussing (59.4 minutes/24 hours [± 25.8 minutes]) and crying (31.2 minutes/24 hours [± 14.4 minutes]) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks' CA compared with infants cared for in DL conditions. No significant difference between groups was observed for sleep behavior at 5 and 11 weeks' CA. Infants in CL conditions showed a trend to improved daily weight gain (average: 3.6 g/d) during neonatal care compared with DL conditions. CONCLUSIONS CL conditions in neonatal care have beneficial effects on infant's fussing and crying behavior and growth in the first weeks of life. This study supports the introduction of CL care in clinical neonatal practice.
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Affiliation(s)
- Caroline Guyer
- Child Development Center, Department of Pediatrics, University Children's Hospital, Zurich, Switzerland
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10
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Spence K, Swinsburg D, Griggs JA, Johnston L. Infant well-being following neonatal cardiac surgery. J Clin Nurs 2011; 20:2623-32. [PMID: 21605213 DOI: 10.1111/j.1365-2702.2011.03716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate infant well-being as measured by feeding and sleeping and parental support following discharge from the NICU in infants following major cardiac surgery. BACKGROUND Infant feeding and sleeping have been identified as two of the most important concerns reported by parents. These concerns have been reported anecdotally for infants who have undergone cardiac surgery in the neonatal period. DESIGN A prospective study using questionnaires and phone interviews followed a cohort of parents of neonates who underwent surgery in the neonatal period for congenital heart disease. METHODS The study was conducted using validated questionnaires and phone interviews with a semi-structured questionnaire. The questionnaires were administered prior to discharge from the NICU and interviews took place following discharge on five occasions within nine months. RESULTS Fifty six infants and mothers were followed for nine months following discharge from NICU. Sixty-eight per cent were breastfeeding on discharge however the rates decline over time in line with healthy infants. Mothers were not bothered by their infant's sleep patterns which were consistent with those of healthy infants at six months. There were 37 episodes of re-hospitalisation and the average time of further surgery was five months following discharge from their initial period of hospitalisation. CONCLUSION The issues from this pilot study warrant further investigation. Factors such as multiple hospitalisations, parent education and support may vary within contexts and need to be studied to ensure optimal supports are identified for this high risk population. RELEVANCE TO CLINICAL PRACTICE This study identified several issues that can improve care provided to these infants and their parents. Support following discharge could include: lactation consultant to provide follow-up calls to identify concerns with breastfeeding, lactation course for paediatric nurses providing follow-up and education for Early Childhood Clinics on Congenital Heart Disease.
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Affiliation(s)
- Kaye Spence
- Clinical Nurse Consultant, Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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11
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OZAWA M, SASAKI M, KANDA K. Effect of procedure light on the physiological responses of preterm infants. Jpn J Nurs Sci 2010; 7:76-83. [DOI: 10.1111/j.1742-7924.2010.00142.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Asaka Y, Takada S. Activity-based assessment of the sleep behaviors of VLBW preterm infants and full-term infants at around 12 months of age. Brain Dev 2010; 32:150-5. [PMID: 19136227 DOI: 10.1016/j.braindev.2008.12.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/05/2008] [Accepted: 12/11/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study is to identify the characteristics of sleep behaviors assessed from activity data among very low-birth weight (VLBW) preterm infants in comparison to full-term infants at the age of around 12 corrected months, due to the possibility that sleep behaviors of preterm infants may be different from those of full-term infants. METHOD Cross-sectional study. Infant sleep measures were obtained through actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY), which were attached to the infants' ankles during a week-long period. The subjects were 14 preterm infants and 14 full-term infants in which the mean ages were 13.3+/-2.1 corrected months and 12.3+/-2.4 month, respectively. RESULTS Preterm infants showed significantly less sleep duration during nighttime than full-term infants. The mean activity score and ACTX (Activity Index: percentage minutes with more than 0 activity score) of preterm infants during nighttime were significantly higher than those of full-term infants. No significant differences in total sleep duration, daytime sleep duration, the number of night-wakings, and sleep efficiency were found between the two groups. CONCLUSION Preterm infants slept less and had a larger percentage of less restful sleep during nighttime. The results indicated that prematurity at the time of birth remained throughout the developmental course of sleep behaviors among preterm infants at around the age of 12 corrected months.
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Affiliation(s)
- Yoko Asaka
- Kobe University Graduate School of Health Sciences, Japan.
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13
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TAKAYA R, FUKUDA K, UEHARA H, KIHARA H, ISHIHARA K. Emergence of the circadian sleep-wake rhythm might depend on conception not on birth timing. Sleep Biol Rhythms 2009. [DOI: 10.1111/j.1479-8425.2009.00386.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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The development of potentially better practices to support the neurodevelopment of infants in the NICU. J Perinatol 2007; 27 Suppl 2:S48-74. [PMID: 18034182 DOI: 10.1038/sj.jp.7211844] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the existing evidence used to identify potentially better care practices that support newborn brain development. STUDY DESIGN Literature review. RESULT Sixteen potentially better practices are identified and grouped into two operational clinical bundles based upon timing for recommended implementation. CONCLUSION Existing evidence supports the implementation of selected care practices that potentially may support newborn brain development.
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15
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Wang X, Allen C, Ballow M. Retinoic acid enhances the production of IL-10 while reducing the synthesis of IL-12 and TNF-alpha from LPS-stimulated monocytes/macrophages. J Clin Immunol 2007; 27:193-200. [PMID: 17253143 DOI: 10.1007/s10875-006-9068-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 12/26/2006] [Indexed: 10/23/2022]
Abstract
Vitamin A and its metabolites, e.g., all trans-retinoic acid (atRA) and 9-cis-retinoic acid have attracted considerable attention as compounds that have a broad range of immune modulating effects on both humoral and cellular immune responses. The cellular and molecular mechanisms that underlie the effects of retinoids on the immune system remain to be more clearly defined. These immune modulating effects of atRA may be mediated by cytokines elaborated by monocytes and other cell types. To further understand the mechanism(s) by which retinoids affect the immune response, we examined the effects of atRA on several proinflammatory and immune modulating cytokines produced by monocytes. The effects of atRA on LPS-induced mRNA expression of IL-10, IL-12p40, TNF-alpha, IL-18, and TGF-beta in the THP-1 monocyte/macrophage cell line and in cord blood mononuclear cells were measured by competitive RT-PCR. The ELISPOT was employed to evaluate IL-10 and TNF-alpha protein production enumerating the number of IL-10 and TNF-alpha producing cells. The addition of atRA to cell cultures potentiated the LPS-induced IL-10 mRNA expression and the number of IL-10 secreting cells from THP-1 cells and cord blood mononuclear cells. In contrast, the addition of atRA inhibited the LPS-induced TNF-alpha and IL-12p40 mRNA expression, and the number of ELISPOT positive cells for TNF-alpha. atRA did not change the LPS-induced mRNA expression of IL-18 and TGF-beta. These results suggest that atRA may have multiple effects on LPS-induced monocyte/macrophage derived cytokines. While atRA downregulated the proinflammatory cytokines, e.g., IL-12 and TNF-alpha, the production of an immune modulating cytokine, IL-10 was enhanced by atRA. The effects of atRA on these cytokines may play an important role in the modulation of the immune and inflammatory responses.
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Affiliation(s)
- Xiaochuan Wang
- Children's Hospital, Medical Center of Fudan University, Shanghai, P.R. China
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16
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SEGAWA M. Epochs of development of the sleep-wake cycle reflect the modulation of the higher cortical function particular for each epoch. Sleep Biol Rhythms 2006. [DOI: 10.1111/j.1479-8425.2006.00205.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Jenni OG, Deboer T, Achermann P. Development of the 24-h rest-activity pattern in human infants. Infant Behav Dev 2005; 29:143-52. [PMID: 17138270 DOI: 10.1016/j.infbeh.2005.11.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 09/26/2005] [Indexed: 11/17/2022]
Abstract
The development of the 24-h rest-activity pattern was investigated in human infants under naturalistic conditions as assessed by continuous actigraphy. Seven infants and their mothers were recorded for 4 (n=1), 6 (n=5) and 12 months (n=1) after birth. Periodogram analysis of rest-activity data was performed over consecutive 10-day intervals. A weak 24-h rest-activity pattern was already present in some infants during the newborn period. The magnitude of the 24-h component in individual periodograms increased across the first months following a saturating function. The time constants of fitted saturating exponential functions--reflecting the rate of development of the 24-h pattern--ranged from 49 to 110 days (n=6) indicating a large interindividual variability. Furthermore, intraindividual variation was observed; the magnitude of the 24-h rest-activity component showed fluctuations around the trend. Miniaturized actigraphs are ideal tools for long-term longitudinal monitoring of rest-activity behavior in infants.
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Affiliation(s)
- Oskar G Jenni
- Growth and Development Center, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
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18
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Kidd S, Midgley P, Nicol M, Smith J, McIntosh N. Lack of Adult-Type Salivary Cortisol Circadian Rhythm in Hospitalized Preterm Infants. Horm Res Paediatr 2005; 64:20-7. [PMID: 16088204 DOI: 10.1159/000087324] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 04/26/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Knowledge of the presence or absence of cortisol (F) circadian rhythm in preterm infants is important for the interpretation of F measurements made in samples taken for both clinical and research purposes. Little is known about its emergence in very preterm infants. This study examines circadian rhythm in F secretion in hospitalized infants born before 30 weeks' gestation. METHODS DESIGN Prospective longitudinal observational study. SUBJECTS 11 infants admitted consecutively and born before 30 completed weeks of gestation. MEASUREMENTS F was measured by highly specific radioimmunoassay on morning and evening saliva samples gathered at weekly intervals until discharged home. Circadian rhythm was defined as > or =40% reduction from morning to evening level. RESULTS For all data, the median salivary F was 10.3 nmol/l (range <0.5-372.8). F levels were highest in the first 3 weeks of life. No infants displayed classical circadian rhythm for 4 weeks or more prior to being discharged from hospital. The other infants showed randomly distributed morning and evening F values with a trend in 4 infants towards periods of consistently higher evening than morning values. CONCLUSION Adult-type F circadian rhythm is rarely evident in hospitalized preterm infants born before 30 weeks' gestation.
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Affiliation(s)
- Susan Kidd
- Department of Child Life and Health, University of Edinburgh and Neonatal Unit, Simpson Center for Reproductive Health, Royal Infirmary Edinburgh, Edinburgh, UK
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19
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Natale V, Sansavini A, Trombini E, Esposito MJ, Alessandroni R, Faldella G. Relationship between preterm birth and circadian typology in adolescence. Neurosci Lett 2005; 382:139-42. [PMID: 15911137 DOI: 10.1016/j.neulet.2005.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 02/25/2005] [Accepted: 03/03/2005] [Indexed: 10/25/2022]
Abstract
A possible relationship between preterm birth and circadian typology was investigated in two pilot survey studies involving 13-year-old teen-agers. Two different questionnaires were used: the Junior Morningness-Eveningness Questionnaire (MEQ) (administered to 55 preterm and 210 fullterm subjects) and the Junior Composite Scale (CS) (administered to 40 preterm and 318 fullterm subjects). In both surveys, preterm groups presented significantly higher total scores, indicating a higher propensity to morningness. Indeed in the preterm samples no evening types were found. The results are discussed in relation to recent models of circadian regulation of the sleep-wake cycle.
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Affiliation(s)
- Vincenzo Natale
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy.
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20
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Abstract
The origin of sleep and circadian rhythms development is found during the fetal period. Both quiet (NREM) and active (REM) sleep are distinguishable during the last 10 weeks of gestation. Comparable to fetuses, low risk preterm infants recorded at 30-40 weeks postconceptional age, had a similar development of sleep i.e. an increase in quiet sleep and a decrease in indeterminate sleep. A further development in sleep organization characterized by increased slow wave and spindle activity during quiet sleep and coupling with circadian rhythm takes place during the first 6 months of life in both term and preterm infants.Circadian rhythm of fetal heart rate synchronized with maternal rest-activity, heart rate, cortisol, melatonin, and body temperature rhythms is present during the last 10 weeks of gestation. Although maternally influenced, circadian rhythm antenatally becomes ultradian at birth. Both preterm and term infants show a significant increase in circadian body temperature rhythm amplitude during the first 3 months of life.
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Affiliation(s)
- Majid Mirmiran
- Department of Pediatrics, School of Medicine, Stanford University, Amsterdam, The Netherlands.
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21
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Shimada M, Segawa M, Higurashi M, Kimura R, Oku K, Yamanami S, Akamatsu H. Effects of phototherapy in neonates on circadian sleep-wake and saliva cortisol level rhythms. J Perinat Neonatal Nurs 2003; 17:222-31. [PMID: 12959483 DOI: 10.1097/00005237-200307000-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The influence of phototherapy treatment during the neonatal period on sleep-wake rhythm, and its long-term effects on biological rhythms, was evaluated in preterm and full-term infants. Forty-three infants treated with phototherapy during the neonatal period and 47 untreated infants were examined for entrainment of sleep-wake rhythms between 16 and 52 weeks and for sleep-wake and saliva cortisol rhythms at 2.5 years of age. The age of sleep-wake rhythm entrainment was not significantly different between the 2 groups. No correlations between duration of exposure to phototherapy and corrected age of entrainment of sleep-wake rhythm were observed. At follow-up, no significant differences in sleep-wake and saliva cortisol rhythms were observed between the 2 groups, indicating that circadian variations were similar to those in adults.
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Affiliation(s)
- Mieko Shimada
- Department of Maternal and Child Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka Prefecture, Japan.
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Mirmiran M, Baldwin RB, Ariagno RL. Circadian and sleep development in preterm infants occurs independently from the influences of environmental lighting. Pediatr Res 2003; 53:933-8. [PMID: 12621096 DOI: 10.1203/01.pdr.0000061541.94620.12] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigated the effect of intermediate nursery illumination on circadian rhythm and sleep development of preterm infants. Preterm infants were randomly assigned to one of two intermediate nursery rooms: a dimly lighted room, the dim (control) group, or a day-night lighted room, the cycled (intervention) group. Continuous rectal temperature and sleep were recorded at 36 wk postconceptional age (before discharge) and at 1 and 3 mo corrected age at home. Forty infants, 21 in the dim group and 19 in the cycled group, were recorded. The clinical demographic data and neonatal scores were similar between groups before the intervention. Circadian rhythms and sleep showed significant development with age, but there was no environmental lighting effect. Circadian and sleep organization seems to develop endogenously in preterm infants.
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Affiliation(s)
- Majid Mirmiran
- Department of Pediatrics, Stanford University School of Medicine, CA 94304, USA
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23
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Abstract
A substantial number of VLBW graduates of intensive care develop cognitive and behavioral problems, even in the absence of neuroimaging abnormalities. Although this article has highlighted the potential, important, contributing role of medical and stressful, neonatal, environmental conditions to the development of these deficits, it is not all-encompassing, and there are additional prenatal (ie, in utero stress, drug exposure) and neonatal (ie, infectious) contributing factors. The long-term, outcome data presented in this article are pertinent to the more mature, VLBW infant, and it remains unclear and critically important to delineate the long-term, neurobehavioral outcome of those extremely low birth-weight survivors born at the cutting limit of viability.
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MESH Headings
- Basal Ganglia/growth & development
- Basal Ganglia/injuries
- Brain/growth & development
- Causality
- Child Behavior Disorders/etiology
- Child Behavior Disorders/prevention & control
- Cognition Disorders/etiology
- Cognition Disorders/prevention & control
- Developmental Disabilities/etiology
- Developmental Disabilities/prevention & control
- Health Facility Environment/standards
- Hippocampus/growth & development
- Hippocampus/injuries
- Humans
- Infant Nutritional Physiological Phenomena
- Infant, Newborn
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/psychology
- Infant, Premature, Diseases/therapy
- Infant, Very Low Birth Weight
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/standards
- Noise/adverse effects
- Psychology, Child
- Treatment Outcome
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Affiliation(s)
- Jeffrey M Perlman
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.
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Abstract
Studies on sleep parameters of Rett syndrome revealed hypoactivity of the noradrenaline (NA) and the serotonin (5HT) neuron in early infancy while preserving the function of the dopamine (DA) and the cholinergic neurons of the pons normally. The sleep-wake cycle remains in its development at the level of 4 months of age. Polysomnographies also showed a decrease of the function of the nigrostriatal (NS)-DA neuron in early childhood and suggested the development of receptor supersensitivity in late childhood. Neurohistochemical and neuroimaging (PET) studies revealed the hypofunction of the NS-DA neuron with receptor supersensitivity and of involvement of the cholinergic neurons to the cortical pathology, whereas no substantial pathological or histochemical abnormalities were observed in the NA and the 5HT neurons in the brainstem. The decrease of tyrosine hydroxylase without neurodegenerative changes observed in the substantia nigra of Rett syndrome had similarity to the pathology caused by excitotoxic lesion of the pedunculopontine nuclei (PPN) observed in an animal experiments. Clinically the grade of disability of locomotion was shown to correlate to the grade of the disabilities of language. These clinical manifestations were also correlated to the specific loci of the mutation in the methyl binding domain of the MECP2 gene. In rodents the axons of the brainstem 5HT neuron involved in the morphogenesis of the brain in the early developmental course disappear in neonates without apoptotic or degenerative changes in the neurons. This period corresponds to the first 1.5-2 years in humans. Thus, in Rett syndrome, the primary lesion appears in the brainstem NA and 5HT neurons which affects development of synaptogenesis of the cortex and also dysfunction of the PPN. The latter causes dysfunction of the DA neuron and the cholinergic neuron in the midbrain. The mutation of the MECP2 gene may cause early transcription of the genes which prune the axons of the aminergic neurons for the developmental morphogenesis of the central nervous system in early infancy.
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Affiliation(s)
- M Segawa
- Segawa Neurological Clinic for Children, 2-8 Surugadai, Kanda Chiyodaku, 101-0062, Tokyo, Japan.
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25
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Perlman JM. Neurobehavioral deficits in premature graduates of intensive care--potential medical and neonatal environmental risk factors. Pediatrics 2001; 108:1339-48. [PMID: 11731657 DOI: 10.1542/peds.108.6.1339] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There is growing evidence that a large number of very low birth weight infants are exhibiting neurobehavioral problems in the absence of cerebral palsy at follow-up that has extended into school age and adolescence. Many clinical factors (ie, chronic lung disease, recurrent apnea and bradycardia, transient hypothyroxemia of prematurity, hyperbilirubinemia, nutritional deficiencies, glucocorticoid exposure), as well as stressful environmental conditions, including infant-provider interaction, constant noise, and bright light, may act in combination to impact on the developing brain, even in the absence of overt hemorrhage and/or ischemia. Any potential intervention strategy designed to prevent cognitive and behavioral problems has to account for the numerous biological and clinical conditions and/or interventions, as well as postdischarge social and environmental influences.
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Affiliation(s)
- J M Perlman
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas 75390-9063, USA.
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Kennedy KA, Fielder AR, Hardy RJ, Tung B, Gordon DC, Reynolds JD. Reduced lighting does not improve medical outcomes in very low birth weight infants. J Pediatr 2001; 139:527-31. [PMID: 11598599 DOI: 10.1067/mpd.2001.117579] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To objectively assess the effect of light reduction as an isolated environmental intervention on neonatal morbidity. STUDY DESIGN Randomized multicenter trial. Neonates < 1251 g birth weight and < 31 weeks gestational age were randomly assigned to receive goggles or to a control group. Goggles that reduced visible light by 97% were placed within 24 hours of birth and remained in use until 31 weeks postmenstrual age or for a minimum of 4 weeks. RESULTS Four hundred nine infants were enrolled, and outcome data are reported for 359 surviving infants. There were no significant differences between the groups in weight gain, duration of oxygen therapy, mechanical ventilation, or hospital stay either in the unadjusted analyses or in the analyses adjusted for birth weight, gestational age, race, sex, and inborn (born in study hospital) status. There was no difference between the groups in the incidence of intracranial hemorrhage. CONCLUSIONS This randomized trial of continuous light reduction in the first few weeks of life for very low birth weight infants showed no effect on medical outcomes.
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Affiliation(s)
- K A Kennedy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
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Castro M, Elias PC, Martinelli CE, Antonini SR, Santiago L, Moreira AC. Salivary cortisol as a tool for physiological studies and diagnostic strategies. Braz J Med Biol Res 2000; 33:1171-5. [PMID: 11004717 DOI: 10.1590/s0100-879x2000001000006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushing's syndrome (CS) in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX) suppression test. Salivary cortisol was suppressed to less than 100 ng/dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h), and 91 and 94% (after DEX), respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h), and 100/95% (1 mg DEX), respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis.
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Affiliation(s)
- M Castro
- Divisão de Endocrinologia, Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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28
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Mirmiran M, Ariagno RL. Influence of light in the NICU on the development of circadian rhythms in preterm infants. Semin Perinatol 2000; 24:247-57. [PMID: 10975431 DOI: 10.1053/sper.2000.8593] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The fetal biological clock is an endogenous clock capable of generating circadian rhythms and responding to maternal entraining signals. By at least the third trimester of pregnancy fetal diurnal rhythms are entrainable by maternal day-night rhythms. Maternal illness during pregnancy and premature birth are obvious clinical factors that may adversely affect circadian rhythm development. Premature birth of the fetus has a most dramatic impact on maternal fetal interactions. The effect on biorhythms appears to be temporary and is greatest on the most immature infants. The results to date support the importance of fetal circadian rhythms and the relative lack of these rhythms in the preterm infant. It is well known that growth and development in the prematurely born infant are influenced by a multitude of factors; clearly, the neonatal intensive care unit is not a surrogate for the maternal placental unit. This article reviews what is known about circadian development in the human infant with an emphasis on the unique circumstances of the preterm infant. The research on the short- and long-term effects of environmental interventions on circadian, sleep, and neurologic development is discussed. Although an earlier onset of circadian development did not result with cycled lighting in the neonatal nursery, there may still be important biological effects that have not been studied. There are sufficient data to state that there is no reason for continuing a chaotic, noncircadian environmental approach for the care of the prematurely born infant.
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Affiliation(s)
- M Mirmiran
- Department of Pediatrics, Stanford University, Palo Alto, CA 94305-5119, USA.
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29
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Abstract
The lighting environment of the preterm baby is quite unlike that experienced at any other time of life. Physical and physiological factors control how much light reaches the retina of the preterm baby. With respect to the former, although many neonatal intensive care units are brightly and continuously lit, there is a trend to employ lower levels of illumination and to introduce cycling regimens. Physiological determinants of the retinal light dose include: eyelid opening and transmission, pupil diameter and the transmission characteristics of the ocular media. Early exposure to light does not significantly hasten or retard normal visual development, and it is not a factor in the development of retinopathy of prematurity. However, ambient neonatal intensive care unit illumination may be implicated in some of the more subtle visual pathway sequelae that cannot be attributed to other major complications of preterm birth including altered visual functions and arrested eye growth.
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Affiliation(s)
- A R Fielder
- Imperial College of Science, Technology and Medicine, Imperial College School of Medicine, London, UK.
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30
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Thomas KA. Differential effects of breast- and formula-feeding on preterm infants' sleep-wake patterns. J Obstet Gynecol Neonatal Nurs 2000; 29:145-52. [PMID: 10750680 DOI: 10.1111/j.1552-6909.2000.tb02034.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare sleep-wake patterns of breastfed and formula-fed preterm infants. DESIGN Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports. SETTING Infants were studied in the home after discharge from a neonatal intensive-care unit. PARTICIPANTS The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment. MAIN OUTCOME MEASURE The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry. RESULTS Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants. CONCLUSION Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.
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Affiliation(s)
- K A Thomas
- Department of Family and Child Nursing, University of Washington, Seattle 98195-7262, USA.
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Shimada M, Takahashi K, Segawa M, Higurashi M, Samejim M, Horiuchi K. Emerging and entraining patterns of the sleep-wake rhythm in preterm and term infants. Brain Dev 1999; 21:468-73. [PMID: 10522524 DOI: 10.1016/s0387-7604(99)00054-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It has been repeatedly reported that the sleep-wake rhythm in infants entrains around 3-4 months of age after a transient free-run rhythm. To clarify the emerging and entraining patterns of the sleep-wake rhythm, the sleep and wakefulness of 84 infants (44 preterm and 40 term infants) were longitudinally recorded at home for more than 16 weeks by the day-by-day plot method. Our results showed that the entrained sleep-wake rhythm emerged after transient manifestation of either ultradian or irregular sleep-wake patterns for 3-4 weeks in 75% of the infants. Only 7% of the infants showed a free-running sleep-wake rhythm before the entrainment. These facts suggest that most infants would be entrained to an ordinary daily schedule of mothers without expression of overt free-running rhythm of the biological clock. The mean age of the entrainment was 44.8 postconceptional weeks. There were no significant differences in either frequency of each pattern or the mean age of the entrainment, between preterm and term infants. In conclusion, the entrained sleep-wake rhythm emerges around 1 corrected month, after ultradian patterns in the majority of infants.
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Affiliation(s)
- M Shimada
- Department of Maternal and Child Health, School of Health Science, Faculty of Medicine, The University of Tokyo, Japan
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Löhr B, Siegmund R. Ultradian and circadian rhythms of sleep-wake and food-intake behavior during early infancy. Chronobiol Int 1999; 16:129-48. [PMID: 10219486 DOI: 10.3109/07420529909019081] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The early development of sleep-wake and food-intake rhythms in human infants is reviewed. The development of a 24 h day-night rhythm contains two observable developmental processes: the alterations in the periodic structure of behavior (decreased ultradian, increased circadian components) and the process of synchronization to external time (entrainment). The authors present the results of their studies involving 26 German children and compare them with previous investigations. In their research, it became evident that, during the first weeks of life, the time pattern of sleep-wake and food-intake behavior is characterized by different ultradian periodicities, ranging from 2 h to 8 h. In the course of further ontogenesis, the share of ultradian rhythms in the sleep-wake behavior decreases, while it remains dominant for food-intake behavior. The circadian component is established as early as the first weeks of life and increases in the months that follow. Besides, the authors' study supports the notion of broad interindividual variation in ultradian rhythms and in the development of a day-night rhythm. Examples of free-running rhythms of sleep-wake and food-intake behavior by various authors are strong indicators of the endogenous nature of the circadian rhythms in infants and show that the internal clock is already functioning at birth. It is still uncertain when the process of synchronization to external and social time cues begins and how differences in the maturation of perceptive organs affect the importance of time cues for the entrainment. Prepartally, the physiological maternal entrainment factors and mother-fetus interactions may be most important; during the first weeks of life, the social time cues gain importance, while light acts as a dominant "zeitgeber" at a later time only.
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Affiliation(s)
- B Löhr
- Department of Human Ethology and Chronobiology, Humboldt-University Charité, Berlin, Germany
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Wolke D, Söhne B, Riegel K, Ohrt B, Osterlund K. An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: comparison with a southern German population sample. J Pediatr 1998; 133:224-31. [PMID: 9709710 DOI: 10.1016/s0022-3476(98)70224-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG). DESIGN Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG. SUBJECTS In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724). MAIN OUTCOME MEASURE Parent reports of child sleeping problems at 5, 20, and 56 months of age. RESULTS Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG. CONCLUSIONS Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding.
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Affiliation(s)
- D Wolke
- University of Hertfordshire, Department of Psychology, Hatfield, Great Britain
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Affiliation(s)
- J Kohyama
- Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Japan
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Ballow M, Xiang S, Wang W, Brodsky L. The effects of retinoic acid on immunoglobulin synthesis: role of interleukin 6. J Clin Immunol 1996; 16:171-9. [PMID: 8734361 DOI: 10.1007/bf01540916] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Retinoic acid (RA) and its parent compound, retinol (ROH, vitamin A), have been recognized as important immunopotentiating agents. Previous studies from our laboratory have demonstrated that RA can augment formalin-treated Staphylococcus aureus (SAC)-stimulated immunoglobulin (Ig) synthesis of cord blood mononuclear cells (CBMC). To determine the mechanism(s) by which RA modulates Ig synthesis, we studied the effects of RA on B cells and cytokine production. The addition of RA (10(-5) to 10(-10) M) to Epstein-Barr virus (EBV)-transformed B-cell clones derived from either adult or cord blood B cells augmented Ig secretion twofold. In contrast, cell proliferation was inhibited as measured by 3H-thymidine incorporation. We evaluated two cytokines known to be constitutively produced by EBV cell lines, IL-1 and IL-6. While RA had no effect on IL-1 production, IL-6 synthesis was greatly enhanced (20- to 45-fold), which was also reflected by an increase in steady-state mRNA levels for IL-6 but not TNF-alpha or TGF-beta on Northern blot analysis. Polyclonal rabbit anti-IL-6 antibodies were used to block the augmenting effects of RA on Ig synthesis of adenoidal B cells. RA-induced augmentation in IgG and IgA synthesis was blocked 58 and 29%, respectively, by anti-IL-6 antibodies. These studies suggest that the enhancing effects of RA on Ig synthesis are mediated, at least in part, by the autocrine or paracrine effects of IL-6 on B-cell differentiation.
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Affiliation(s)
- M Ballow
- Department of Pediatrics, Children's Hospital of Buffalo, New York 14222, USA
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Co-morbidity of crying and feeding problems with sleeping problems in infancy: Concurrent and predictive associations. ACTA ACUST UNITED AC 1995. [DOI: 10.1002/edp.2430040405] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The aims of this study were: (1) to investigate the evolution of the sleep pattern in preterm newborns during their first month of life; (2) to assess the influence of light-dark on the sleep pattern; and (3) to compare this pattern with that of full-term newborns. The population consisted of 60 healthy, preterm newborns and 63 full-term newborns, divided into four age groups, 1 week apart, throughout the first month of life. Preterm newborns were further divided into five groups according to conceptional (corrected) age. An observer took note every 30 min, for 24 h, of sleep or wakefulness in every case. The average sleeping time in preterm groups according to postnatal age remained unchanged during the first month of life: 17.57 h on day 1 and 17.15 h on day 28. When the preterm infants were re-grouped according to conceptional age, average daily sleep was 17.86 h at 32 weeks and 15.22 h at 37 weeks. The full-term newborns had an average daily sleep of 14.78 h on day 1 and 11.94 h on day 28, with a decrease throughout week 4 of life (p < 0.001). The decrease in daily sleeping time in the full-term groups, took place at the expense of the daylight span, where there was a decrease throughout the first month of life (p < 0.01). There were no differences in preterm newborns during the light and dark phases. A progressive synchronization of sleep to the light-dark was seen in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Ardura
- Departments de Pediatría y Matemática Aplicada, Universidad de Valladolid, Spain
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Wolke D, Meyer R, Ohrt B, Riegel K. The incidence of sleeping problems in preterm and fullterm infants discharged from neonatal special care units: an epidemiological longitudinal study. J Child Psychol Psychiatry 1995; 36:203-23. [PMID: 7759587 DOI: 10.1111/j.1469-7610.1995.tb01821.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anecdotal reports have suggested that sleeping problems are a frequent complaint from parents of preterm infants. This prospective epidemiological study examined the incidence and stability of sleeping problems of very preterm (< 32 weeks gestation at birth), preterm (32-36 weeks gestation) and fullterm infants, all admitted to special care baby units (SCBU) after birth, in comparison to healthy term infants over the first 5 years of life. Preterm infants were found to have fewer and shorter night-wakings at 5 months. No differences in sleeping behaviour compared with healthy term children were found at 20 and 56 months of age. Similar significant, and moderate, stability of nightwaking from one age to the next were found for exSCBU-graduates and healthy fullterm infants. Parental interventions such as staying with the child until sleep and taking the infant into bed af night were related to nightwaking problems and increased parental distress. It is concluded that prematurity, and thus neurological immaturity and special care experience are less important than caretaking behaviour in the development of sleeping problems in both preterm and fullterm infants.
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Affiliation(s)
- D Wolke
- University of Munich Children's Hospital, Germany
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