2.50
Hdl Handle:
http://hdl.handle.net/10755/165848
Category:
Abstract
Type:
Presentation
Title:
Sleeping and waking development in preterm infants
Author(s):
Holditch-Davis, Diane
Author Details:
Diane Holditch-Davis, PhD, Professor, University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA, email: diane_hd@unc.edu
Abstract:
This study examined the development of sleeping and waking during the preterm period in infants at high medical risk and to explore whether similar developmental patterns continue after term. Ninety-nine preterm infants who weighed less than 1500 gm or required mechanical ventilation were recruited from 3 hospitals in 3 different states. Their mean gestational age at birth was 28.8 weeks, and mean birth weight was 1213 gm. They averaged 12.1 days of mechanical ventilation. Weekly observations were conducted from the time infants were no longer critical until 43 weeks post-conceptional age or discharge. Each observation lasted for 2 hours during an inter-feeding period in the daytime. A single follow-up observation was conducted 1-3 months later. A mean of 4 observations were conducted on each infant. During the observation, the occurrence of 5 sleep-wake states (active waking, quiet waking, sleep-wake transition, active sleep, quiet sleep), 4 state-related behaviors (grimace, sigh, large movements, and percent REM in active sleep), and indices of the regularity of respiration in active and quiet sleep were recorded every 10 seconds. Respiration was recorded on a computer. To determine whether these variables exhibited developmental changes, mixed general linear models were calculated for each variable using the linear and quadratic effects of post-conceptional age and an adjustment factor to account for a change in linear trend with the follow-up observations as predictors. Hospital, gender, race, birth weight, theophylline treatment, and the length of mechanical ventilation were used as covariates. An elimination process was used to fit the model. First, the simultaneous effect of the covariates was tested. If this effect was not significant, all covariates were eliminated. Then, the adjustment factor was tested and eliminated if not significant. Third, the quadratic effect was tested and dropped if non-significant. Three of the 5 states exhibited significant development. Active sleep decreased with age, and quiet waking and quiet sleep increased. The regularity of respiration in active sleep and quiet sleep and the percent REM in active sleep increased, and sighs and large movements decreased. Six of the 11 variables showed significant quadratic effects, primarily due to a slowing of development after term. Trends for two variables (non-REM active sleep and quiet sleep respiration regularity) were not consistent with the values predicted from the hospital observations. Covariates had only minor effects on these patterns. Infants in one hospital had 16.3 percent less of non-REM in active sleep than infants in the other two hospitals. An increase in birth weight of 100 grams was related to a decrease in quiet sleep respiratory regularity of 2.1 points. Minority infants scored 13.1 points higher on quiet sleep respiration regularity than white infants. Clearly, much development of sleeping and waking occurs over the preterm period, but in many cases developmental trajectories change after the infant leaves the hospital. Additional research is needed to determine the relative effects of maturation and the hospital and home environments on these shifts in the developmental trajectories.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleSleeping and waking development in preterm infantsen_GB
dc.contributor.authorHolditch-Davis, Dianeen_US
dc.author.detailsDiane Holditch-Davis, PhD, Professor, University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA, email: diane_hd@unc.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/165848-
dc.description.abstractThis study examined the development of sleeping and waking during the preterm period in infants at high medical risk and to explore whether similar developmental patterns continue after term. Ninety-nine preterm infants who weighed less than 1500 gm or required mechanical ventilation were recruited from 3 hospitals in 3 different states. Their mean gestational age at birth was 28.8 weeks, and mean birth weight was 1213 gm. They averaged 12.1 days of mechanical ventilation. Weekly observations were conducted from the time infants were no longer critical until 43 weeks post-conceptional age or discharge. Each observation lasted for 2 hours during an inter-feeding period in the daytime. A single follow-up observation was conducted 1-3 months later. A mean of 4 observations were conducted on each infant. During the observation, the occurrence of 5 sleep-wake states (active waking, quiet waking, sleep-wake transition, active sleep, quiet sleep), 4 state-related behaviors (grimace, sigh, large movements, and percent REM in active sleep), and indices of the regularity of respiration in active and quiet sleep were recorded every 10 seconds. Respiration was recorded on a computer. To determine whether these variables exhibited developmental changes, mixed general linear models were calculated for each variable using the linear and quadratic effects of post-conceptional age and an adjustment factor to account for a change in linear trend with the follow-up observations as predictors. Hospital, gender, race, birth weight, theophylline treatment, and the length of mechanical ventilation were used as covariates. An elimination process was used to fit the model. First, the simultaneous effect of the covariates was tested. If this effect was not significant, all covariates were eliminated. Then, the adjustment factor was tested and eliminated if not significant. Third, the quadratic effect was tested and dropped if non-significant. Three of the 5 states exhibited significant development. Active sleep decreased with age, and quiet waking and quiet sleep increased. The regularity of respiration in active sleep and quiet sleep and the percent REM in active sleep increased, and sighs and large movements decreased. Six of the 11 variables showed significant quadratic effects, primarily due to a slowing of development after term. Trends for two variables (non-REM active sleep and quiet sleep respiration regularity) were not consistent with the values predicted from the hospital observations. Covariates had only minor effects on these patterns. Infants in one hospital had 16.3 percent less of non-REM in active sleep than infants in the other two hospitals. An increase in birth weight of 100 grams was related to a decrease in quiet sleep respiratory regularity of 2.1 points. Minority infants scored 13.1 points higher on quiet sleep respiration regularity than white infants. Clearly, much development of sleeping and waking occurs over the preterm period, but in many cases developmental trajectories change after the infant leaves the hospital. Additional research is needed to determine the relative effects of maturation and the hospital and home environments on these shifts in the developmental trajectories.en_GB
dc.date.available2011-10-27T14:34:58Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:34:58Z-
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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