Clinical Implications for Behavioral Assessment of Sleep/Wake States in Neonates: Augmenting Medical Diagnostic Evaluations
ABSTRACT: The use of behaviorally defined sleep and wake states for detecting or predicting abnormal development in high risk newborn infants is addressed. One case of a relatively low risk 32-week gestation infant is used to illustrate that immediate subjective impressions by a trained observer may reveal information useful to the medical staff without having to wait for the lengthy computer analyses usually performed with this assessment technique. A second case illustrates a situation in which sleep/wake assessment by a trained observer assisted the medical team in confirming their diagnosis of massive brain damage and loss of function in an anencephalic newborn. The use of sleep variables in evaluating other behavioral and medical conditions in the young infant is also discussed.
Ballard, J.L., Novak, K.K., & Driver, M. (1979). A simplified score for assessment of fetal maturation of newly born infants. The Journal of Pediatrics, 95, 769-774.
Becker, P.T. & Thoman, E.B. (1981). Rapid Eye Movement storms in infants: Rate of occurrence at 6 months predicts mental development at 1 year. Science, 212, 1415-1416.
Campbell, S.K. & Wilhelm, I.M. (1982). Developmental sequences in infants at risk for CNS dysfunction: The recovery process in the first year of life. In J.M. Stack (Ed.), An interdisciplinary approach to the optimal development of infants: The special infant. New York: Human Sciences Press.
DeSantis, D.T. (in review). From babies to bunnies and back: Application of an animal model of sleep and prematurity.
DeSantis, D., Waite, S., Thoman, E.B., & Denenberg, V.H. (1977). Effects of isolation rearing upon behavioral state organization in the rabbit. Behavioral Biology, 21, 273-385.
Dinges, D.F., Davis, M.M., & Glass, P. (1979). Fetal exposure to narcotics: Neonatal sleep as a measure of nervous system disturbance. Science, 209, 619-621.
Dubowitz, L.M.S., Dubowitz, V., & Goldberg, C. (1970). Clinical assessment of gestational age in the newborn infant. The Journal of Pediatrics, 77, 1-10.
Guilleminault, C, Ariagno, R., Couquet, M., & Dement, W.C (1976). Abnormal polygraph findings in near-miss Sudden Infant Death. The Lancet, June 19, 1326-1327.
Harper, R.M., Leake, B., Hoffman, H., Walter, D.O., Hoppenbrouwers, T., Hodgman, J., & Sterman, M.B. (1981). Periodicity of sleep states is altered in infants at risk for the Sudden Infant Death Syndrome. Science, 213, 1030-1032.
Hobel, C.J., Hyvarinen, M.A., Okada, D.M., & Oh, W. (1973). Prenatal and intrapartum high-risk screenings: I. Prediction of the high risk neonate. American Journal of Obstetrics and Gynecology, 117, 1-9.
Prechtl, H.F.R. (1977). Assessment and significance of behavioral states. In S.R. Berenberg (Ed.). Brain: Fetal and Infant. The Hague: Martinus-Nijhoff Medical Division.
Prechtl, H.F.R., Theorell, K., & Blair, A.W. (1973). Behavioural state cycles in abnormal infants. Developmental Medicine & Child Neurology, 15, 606-615.
Thoman, E.B., Denenberg, V.H., Sievel, J., Zeidner, L.P., & Becker, P. (1981). State organization in neonates: Developmental inconsistency indicates risk for developmental dysfunction. Neuropediatrics, 12, 45-54.
Thoman, E.B., Waite, S.P., DeSantis, D.T., & Denenberg, V.H. (1979). Ontogeny of sleep and wake states in the rabbit. Animal Behaviour, 27, 95-106.
Waite, S., DeSantis, D., Thoman, E.B., & Denenberg, V.H. (1977). The predictive validity of early sleep development on late behavioral characteristics in the rabbit. Biology of Behaviour, 2, 249-261.
Wolff, P.H. (1966). The causes, controls, and organization of behavior in the neonate. Psychological Issues Monograph No. 17, 5 (1), 1-105.
Darlene T. DeSantis, Ph.D.
Darlene DeSantis is Assistant Professor of Psychology at West Chester University, West Chester, Pennsylvania. She specializes in developmental psychobiology, early assessment, early intervention, and parent-young interactions in high risk infants and animal models. Subjects were observed at North Carolina Memorial Hospital-Chapel Hill; the preterm study was partially funded by grants to the Division of Physical Therapy. Address correspondence to the author at Department of Psychology, West Chester University, West Chester, PA 19383.