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Published on: August 25, 2014
Sleep wake cycling and neurodevelopmental outcome in very low birth weight infants
Mohamed El-Dib1, An N Massaro, Penny Glass
1Department of Neonatology and.
Insights
Sleep wake cycling (SWC) in premature infants at 34 weeks postmenstrual age may predict early neurodevelopmental outcome (NDO). This relationship was not significant at 18 months corrected age, suggesting SWC is an early but not long-term predictor.
Area of Science:
- Neonatal neuroscience
- Developmental pediatrics
Background:
- Sleep-wake cycling (SWC) maturation in premature infants is documented.
- The predictive value of SWC for neurodevelopmental outcome (NDO) remains unclear.
Purpose of the Study:
- To investigate the association between NDO and SWC in very low birth weight (VLBW) infants.
- To utilize amplitude-integrated electroencephalogram (aEEG) for SWC evaluation.
Main Methods:
- Prospective study of VLBW infants (<1500g, ≤34 weeks gestational age).
- 12-hour aEEG recordings at 34 weeks postmenstrual age (PMA) to assess SWC.
- NDO assessed using Bayley Scales (MDI, PDI) at 9 and 18 months corrected age (CA).
Main Results:
- At 9 months CA, SWC score correlated with Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI).
- Severe intraventricular hemorrhage (IVH) also associated with MDI.
- Gestational age (GA) associated with PDI.
- These associations were not significant at 18 months CA.
Conclusions:
- All VLBW infants show some SWC on aEEG by 34 weeks PMA.
- SWC maturation at 34 weeks PMA may indicate early NDO.
- Further research is required to confirm the long-term predictive value of SWC.
Background:
Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its value in predicting neurodevelopmental outcome (NDO) is yet to be known.
Objective:
To examine the relationship between NDO and SWC evaluated by amplitude integrated electroencephalogram (aEEG) in very low birth weight (VLBW) infants.
Study Design:
VLBW infants (<1500 grams and ≤34 weeks gestational age) were enrolled in a prospective study. Two channel 12-hour aEEG recordings were completed at 34 weeks postmenstrual age (PMA) and SWC scores were assigned. NDO was measured by the Bayley's Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 9 and 18 months corrected age (CA).
Results:
Eighty-four of the 103 enrolled infants had an aEEG completed at 34 weeks PMA. At 9 months CA, in linear regression models, MDI was significantly associated with severe intraventricular hemorrhage (IVH) and SWC score, while PDI was associated with GA and SWC score. At 18 months CA, these associations lost significance.
Conclusions:
At 34 weeks PMA, all VLBW premature infants demonstrate some degree of SWC on aEEG. Maturation of SWC at 34 weeks PMA is not associated with gestational age, however may relate to early NDO. Further studies are needed to evaluate this relationship.
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