INDIVIDUALIZED DEVELOPMENTAL CARE FOR VERY LOW BIRTH WEIGHT (VLBW) PREMATURE INFANTS: IMPROVED “STATE SYSTEM CONTROL” WITHOUT ADVANCED DEVELOPMENT IN SLEEP MEASURES USING THE MOTILITY MONITORING SYSTEM (MMS).

Abstract

Objective: We hypothesized that individualized developmental care for the VLBW Neonatal Intensive Care Unit (NICU) infant would result in advanced sleep development (measured by the MMS). Population: We conducted sleep studies using the MMS on 28 preterm infants who were part of a larger group enrolled in the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) at Stanford. Enrollment criteria for this program included birth wt. ≤1250g and mechanical ventilation for more than 24h during the first 48h of life. Infants were randomly assigned to Intervention(INT, n=14) or Control (C, n=14) groups. Groups were similar for severity of illness. Researchers recording and scoring the sleep data were blinded. Care plans were devised and implemented for the INT infants, as described (Als et al. JAMA. 1994). C infants received routine NICU nursing care. Both INT and C infants were evaluated at 42 weeks post-conceptional age (PCA) by a blinded examiner using the Assessment of Premature Infant Behavior (APIB) tool. The APIB assesses an infant's behavior in five areas or systems including“state system control” (evaluation of sleep and wake states for maturity). Methods: MMS technique used a pressure sensitive pad, amplifier, and recorder. Studies were conducted for 48 continuous hours at 36 wks PCA and at 3 mos corrected age (CA). Data were scored for states, state transitions, and out of crib time. Results: INT infants showed better sleep and wake “state system control” than C infants as measured by the APIB (p=.03). However, there was no significant difference between the two groups at either age on any MMS sleep measure. There were significant maturation effects in both groups between 36 wks PCA and 3 mos CA(% Quiet Sleep/Total Sleep Time increase: INT=11, C=6 and% Active Sleep/Total Sleep Time decrease: INT=11, C=6 all p's <0.006). Conclusion: Improved medical outcome measured by shorter time on mechanical ventilation, fewer days to full enteral feeds and decrease in length of hospitalization reported in infants who have had developmental care implemented does not appear to be associated with improvement in sleep development or in the amount of sleep. Improvement in “state system control” occurs without neurodevelopmental maturation in sleep as measured by the MMS.