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Updated: Aug 22, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Sleeping and waking state development in preterm infants
Diane Holditch-Davis1, Mark Scher, Todd Schwartz
1School of Nursing, University of North Carolina at Chapel Hill, CB# 7460, Chapel Hill, NC, 27599-7460, USA. diane_hd@unc.edu
Insights
Preterm infant sleep-wake development shows significant changes, with active sleep decreasing and quiet waking increasing. Environmental factors had minimal impact on these sleep patterns during the hospital stay.
Area of Science:
- Neonatal development
- Sleep science
- Developmental pediatrics
Background:
- Limited longitudinal data exists on preterm infant sleep-wake state development.
- The influence of environmental factors on sleep development in preterm infants remains unclear.
Purpose of the Study:
- To examine the longitudinal development of sleep-wake states in preterm infants.
- To investigate the effects of infant health and environmental characteristics on sleep development.
Main Methods:
- Longitudinal, descriptive study design.
- 134 high-risk preterm infants (birthweight <1500g or mechanical ventilation).
- Weekly behavioral observations until 43 weeks post-conceptional age, with a follow-up observation.
Main Results:
- Active sleep and large body movements decreased with age; quiet waking and sleep regularity increased.
- Sleep-wake transition states changed significantly around 40-43 weeks post-conceptional age.
- Infant characteristics, illness severity, and hospital environment had minor effects on sleep development.
Conclusions:
- Significant development of sleep-wake states occurs during the preterm period.
- Further research is needed to understand the transition to the home environment's impact on sleep trajectories.
Background:
Most studies of sleep-wake states of preterm infants have been cross-sectional. Thus, the extent to which sleep-wake development occurs within individuals and how environmental factors affect the development of sleeping and waking is unclear.
Aims:
This study examined the development of sleeping and waking during the preterm and early post-term periods and the effects of infant health and environmental characteristics.
Design:
Longitudinal, descriptive design.
Participants:
134 preterm infants at high risk for developmental problems because of birthweights under 1500 g or mechanical ventilation.
Outcome Measures:
Weekly 2-h behavioral observations were conducted from the time infants were no longer critically ill until 43 weeks post-conceptional age or discharge. A single follow-up observation was conducted 1-3 months later.
Results:
Active sleep, large body movements and the percent of no REM during active sleep decreased with age, and quiet waking, active waking, quiet sleep and regularity of respiration in active sleep and quiet sleep increased. The state of sleep-wake transition increased until 40 weeks and then decreased after 43 weeks CA. Negative facial expressions showed a quadratic decrease over age. Active waking, active sleep, negative facial expressions and quiet sleep regularity showed a change of development after term. Infant characteristics, illness severity and medical treatments, the handling due to performing an EEG and hospital had only minor effects.
Conclusions:
Significant development of sleeping and waking occurs over the preterm period. Additional research is needed to determine how the change from the hospital to the home environment affects on these developmental trajectories.
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