Size for gestational age and neonatal sleep variables: behavioral indices of risk in fullterm twins

Neonatal sleep behaviors and behavioral state cycling were observed for 20 pairs of same-sex, fullterm twins in which one twin of the pair was appropriate-for-gestational-age (AGA) and the other twin was small-for-gestational-age (SGA). Time-sampling recordings were made in active sleep of number and vigor of limb movements, body and head movements, and mouth movements. No group differences were observed for time spent in first active sleep, first quiet sleep, or length of first sleep cycle. Examination of specific behaviors indicated a significantly higher incidence of vigorous limb movements and right hand-to-mouth movements, with a trend for more small limb movements and left hand-to-face movements, for AGA twins when compared with SGA twins. SGA twins had significantly more spontaneous smiles and a trend for spontaneous startles than AGA twins. A stepwise discriminant analysis indicated that a composite of the variables smile, large limb movement, startle, and left hand-to-face significantly discriminated between the two groups, with 90% correct classification of the AGA twins and 75% correct classification of the SGA twins. The results demonstrated the utility of evaluating specific sleep behaviors, rather than state cycling only, to describe differences in neonatal sleep characteristics between AGA and SGA twins.