Quiet Sleep Organization of Very Preterm Infants Is Correlated With Postnatal Maturation

Background: Sleep is an important determinant of brain development in preterm infants. Its temporal organization varies with gestational age (GA) and post-menstrual age (PMA) but little is known about how sleep develops in very preterm infants. The objective was to study the correlation between the temporal organization of quiet sleep (QS) and maturation in premature infants without severe complications during their neonatal hospitalization. Methods: Percentage of time spent in QS and average duration of time intervals (ADI) spent in QS were analyzed from a cohort of newborns with no severe complications included in the Digi-NewB prospective, multicentric, observational study in 2017-19. Three groups were analyzed according to GA: Group 1 (27-30 weeks), Group 2 (33-37 weeks), Group 3 (>39 weeks). Two 8-hour video recordings were acquired in groups 1 and 2: after birth (T1) and before discharge from hospital (T2). The annotation of the QS phases was performed by analyzing video recordings together with heart rate and respiratory traces thanks to a dedicated software tool of visualization and annotation of multimodal long-time recordings, with a double expert reading. Results are expressed as median (interquartile range, IQR). Correlations were analyzed using a linear mixed model. Results: Five newborns were studied in each group (160 hours of recording). Median time spent in QS increased from 13.0% [IQR: 13-20] to 28.8% [IQR: 27-30] and from 17.0% [IQR: 15-21] to 29.6% [IQR: 29.5-31.5] in Group 1 and 2 respectively. Median ADI increased from 54 [IQR: 53-54] to 288 seconds [IQR: 279-428] and from 90 [IQR: 84-96] to 258 seconds [IQR: 168-312] in Group 1 and 2. Both groups reach values similar to that of group 3 respectively 28.2% [IQR: 24.5-31.3] and 270 seconds [IQR: 210-402]. The correlation between PMA and time spent in QS or ADI were respectively 0.73 (p<10-4) and 0.46 (p=0.06). Multilinear analysis using temporal organization of QS gave an accurate estimate of PMA (r2=0.87, p<0.001). Conclusion: The temporal organization of QS is correlated with PMA in newborns without severe complication. An automated standardized continuous behavioral quantification of QS could be interesting to monitor during the hospitalization stay in neonatal units.