title: Sleep-wake transitions in premature neonates predict early development.
abstract: OBJECTIVE
  To identify patterns of sleep-wake transitions in the neonatal period that might differentiate premature infants who would show better or worse outcomes in multiple developmental domains across the first 5 years of life.
  
  
  METHODS
  Participants were 143 low birth weight premature infants (mean birth weight: 1482 g; mean gestational age [GA]: 31.82 weeks). Sleep states were observed at a GA of 37 weeks in 10-second epochs over 4 consecutive evening hours and were analyzed through mathematical clustering. Neurobehavioral maturation was evaluated with the Neonatal Behavior Assessment Scale at discharge, emotional regulation was assessed during infant-mother and infant-father interactions at 3 and 6 months, cognitive development was measured at 6, 12, and 24 months, and verbal IQ, executive functions, and symbolic competence were tested at 5 years.
  
  
  RESULTS
  Three types of state-transition patterns were identified, and no differences in birth weight, GA, or medical risk between the 3 groups were found. Infants whose sleep-state transitions were mainly characterized by shifts between quiet sleep and wakefulness exhibited the best development, including greater neonatal neuromaturation, less negative emotionality, better cognitive development, and better verbal, symbolic, and executive competences at 5 years. In comparison, infants who cycled mainly between states of high arousal, such as active sleep and cry, or between short episodes of active and quiet sleep showed poorer outcomes.
  
  
  CONCLUSIONS
  Defining sleep organization on the basis of transitions between states proved useful for identifying risk and resilience indicators in neonatal behavior to predict trajectories of neurobehavioral, emotional, and cognitive growth.
authors.affiliation: Department of Psychology, Bar-Ilan University, Ramat-Gan 52900, Israel.
authors.forename: Omri
authors.initials: O
authors.lastname: Weisman
authors.forename: Reuma
authors.initials: R
authors.lastname: Magori-Cohen
authors.forename: Yoram
authors.initials: Y
authors.lastname: Louzoun
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Eidelman
authors.forename: Ruth
authors.initials: R
authors.lastname: Feldman
mesh_terms: D000328:Adult; D001683:Biological Clocks / Q000502:physiology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D016000:Cluster Analysis; D003071:Cognition / Q000502:physiology; D004644:Emotions / Q000502:physiology; D056344:Executive Function; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology / Q000523:psychology; D007230:Infant, Low Birth Weight / Q000502:physiology / Q000523:psychology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology* / Q000523:psychology; D007360:Intelligence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012890:Sleep / Q000502:physiology*; D013561:Symbolism; D014706:Verbal Learning; D014851:Wakefulness / Q000502:physiology*