Co-developing sleep-wake and sensory foundations for cognition in the human fetus and newborn

In older children and adults, cognition builds upon waking sensory experience which is consolidated during sleep. In the fetus and newborn, sensory input is instead largely experienced during sleep. The nature of these sensory inputs differs within sleep, between active and quiet sleep, as well as versus wakefulness. Here, sleep-wake organisation in the fetus and newborn is reviewed, and then its interaction with sensory inputs discussed with a focus on somatosensory and auditory modalities. Next, these ideas are applied to how neurological insults affect early development, using fetal growth restriction as a test case. Finally, the argument is made that taking account of sleep-wake state during perinatal functional neuroimaging can better index sensorimotor, language, and cognitive brain activities, potentially improving its diagnostic and prognostic value. To sum up, sensory and sleep-wake functions go hand in hand during early human development. Perturbation of these twinned functions by neurological insults may mediate later neurodevelopmental deficits. Perinatal neuroimaging has the potential to track these trajectories, feasibly identifying opportunities to therapeutically intervene.