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PubMed2003

Clinicopathological correlation between brainstem gliosis using GFAP as a marker and sleep apnea in the sudden infant death syndrome.

BACKGROUND: Chronic hypoxia, leading to brainstem gliosis, has been postulated as a factor in the sudden infant death syndrome (SIDS), which is still the main cause of postneonatal infant death. Gliosis detected by immunohistochemistry of glial fibrillary acidic protein (GFAP) is a marker of apoptosis. The correlation between GFAP-positive reactive astrocytes in the brainstem and sleep apnea in SIDS was investigated. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age, including 26 cases of SIDS. The frequency and duration of sleep apnea were analyzed. Brainstem material was collected and immunohistochemistry of GFAP carried out. The density of GFAP-positive reactive astrocytes was measured quantitatively. Correlation analyses were carried out between the data on gliosis and the physiological data of sleep apnea. RESULTS: A SIDS-specific negative correlation between the density of gliosis in the dorsal vagus nucleus in the medulla oblongata and the frequency of obstructive apnea (p=0.022) was found. CONCLUSIONS: A significant SIDS-specific correlation with gliosis in the dorsal vagus nucleus and the characteristics of sleep apnea might invite the cardiorespiratory changes in SIDS.

Astrocytes↗
PubMed2003

Pathological data on apoptosis in the brainstem and physiological data on sleep apnea in SIDS victims.

UNLABELLED: The sudden infant death syndrome (SIDS) is still the main cause of postneonatal infant death and its cause is still unknown. A chronic hypoxic situation has been shown to exist in the brains of SIDS victims and apoptosis has been demonstrated in hypoxic situations. In this study, the correlation between apoptotic neurons or glias and sleep apnea in SIDS was investigated in the brainstem of SIDS victims. MATERIALS AND METHODS: In a cohort of 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age. They included 26 cases of SIDS. The frequency and duration of sleep apnea were analyzed. The brainstem material was collected and terminal-deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method was carried out. The density of TUNEL-positive neurons or glias was measured quantitatively. Correlation analyses were carried out between the apoptosis-associated pathological data and the physiological data of sleep apnea. RESULTS: No significant negative or positive correlation between the density of TUNEL-positive neurons or glias and the characteristics of sleep apnea was observed in SIDS victims. No statistically significant differences associated with apoptotic neurons and glias were observed between SIDS and non-SIDS. CONCLUSIONS: The pathological findings of apoptosis were not in agreement with the hypothesis refer to apnea and arousal phenomenon in pathophysiology of SIDS.

Apoptosis↗
PubMed2003

Investigation into the correlation in SIDS victims between Alzheimer precursor protein A4 in the brainstem and sleep apnea.

BACKGROUND: Recently, the appearance of beta-amyloid precursor protein (APP) has been demonstrated in the neonatal brain following hypoxic-ischaemic injury. As chronic hypoxia is one of the favoured theories of causation in the sudden infant death syndrome (SIDS), the correlation between APP in the brainstem and sleep apnea in SIDS was investigated. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age, which included 26 cases of SIDS. All the infants had been recorded during one night in a pediatric sleep laboratory, some 3 to 12 weeks before death. The frequency and duration of sleep apnea were analyzed. The brainstem material was collected and immunohistochemistry with anti-Alzheimer precursor protein A4 (APP) was carried out. The density of APP-positive elements was measured semi-quantitatively. Correlation analyses were carried out between the density of APP-positive elements and the data on sleep apnea. RESULTS: No correlation was found. CONCLUSION: No correlation between pathological data of APP and physiological data of sleep apnea was not in agreement with the association of sleep apnea in pathophysiology of SIDS.

Amyloid beta-Protein Precursor↗
PubMed2003

Catecholaminergic neurons in the brain-stem and sleep apnea in SIDS victims.

BACKGROUND: Tyrosine hydroxylase (TH) is a specific marker for catecholaminergic neurones. Some reports have demonstrated a decrease of TH in the Sudden Infant Death Syndrome (SIDS) compared with controls. To further investigate this, the correlation between TH and sleep apnea was investigated here. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age. They included 26 cases of SIDS. All the infants had been recorded during one night in a pediatric sleep laboratory some 3 to 12 weeks before death. The frequency and the duration of sleep apnea were analyzed. The brain stem material was collected and subjected to immunohistochemical studies for TH. The density of TH-immunoreactive neurons was measured in the nucleus hypoglossus, nervus vagus dorsalis, solitary and ambiguous and the ventrolateral medulla (VLM) in the medulla oblongata. Correlation analyses were carried out between the density of TH-immunoreactive neurons and the data from the sleep apnea studies. RESULTS: There was no SIDS specific correlation between TH-immunoreactive neurons in the nucleus hypoglossus, nervus vagus dorsalis, solitary and ambiguous and the ventrolateral medulla (VLM) in the medulla oblongata and the frequency and duration of sleep apnea. CONCLUSIONS: No significant association between the pathological data and the physiological data refers to TH positive neurons in the medulla oblongata in SIDS victims.

Brain Stem↗
PubMed2003

Substance P in the midbrains of SIDS victims and its correlation with sleep apnea.

BACKGROUND: Substance P (SP) is a neuropeptide transmitter found in sensory neurons of the central nervous system and related to pain sensation and respiratory regulation. Some reports claim an increase in SP in the brains of SIDS victims, so the correlation between SP and sleep apnea was investigated here. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age, which included 26 cases of Sudden Infant Death Syndrome (SIDS). All the infants had been recorded during one night in a pediatric sleep laboratory some 3 to 12 weeks before death. The frequency and duration of sleep apnea were analyzed. Brainstem material was collected and immunohistochemistry for SP was carried out. The density of SP positive fibers was measured in the nucleus spinal and mesencephalic nervi trigemini and nucleus parabranchialis in the brainstem of abovementioned cases. Correlation analyses were carried out between the density of SP and the data of sleep apnea. RESULTS: There was no SIDS specific correlation of SP through the above-listed parts of the midbrain with frequency and duration of sleep apnea. CONCLUSIONS: There was no significant association between the SP findings and apnea data in SIDS; this is not in agreement with the association of apnea in pathophysiology of SIDS.

Double-Blind Method↗
PubMed2003

Serotonergic receptors in the midbrain correlated with physiological data on sleep apnea in SIDS victims.

BACKGROUND: Recently it has been reported that serotonin and related matters are associated with the sudden infant death syndrome (SIDS), which is still the main cause of postneonatal infant death. To further explore this claim, the correlation between serotonin receptors in the brainstem and sleep apnea in SIDS victims was investigated. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age including 26 cases of SIDS. All the infants had been recorded during one night in a pediatric sleep laboratory some 3-12 weeks before death. The frequency and duration of sleep apnea were analyzed. Brainstem material was collected and immunohistochemistry on 5-hydroxy tryptamine 1A (5HT1A) receptor was carried out. The density of 5HT1A receptor-positive neurons was measured quantitatively. Nonparametric analysis of the density of 5HT1A receptor-positive neurons was carried out between SIDS and non-SIDS cases. Correlation analyses were performed between the density of 5HT1A receptor-positive neurons and the data on sleep apnea. RESULTS: There was no correlation between the pathological data on 5HT1A receptors and the physiological data on sleep apnea in SIDS victims. CONCLUSIONS: No correlation between pathological findings of serotonin and physiological findings of sleep apnea were not in agreement with the association of sleep apnea in pathophysiology of SIDS.

Brain Stem↗
PubMed2003

The correlation between ubiquitin in the brainstem and sleep apnea in SIDS victims.

BACKGROUND: The sudden infant death syndrome (SIDS) is still the main cause of postneonatal infant death and its etiology has stimulated many competing theories, among which is the role of hypoxia and brainstem abnormalities. One report claims an increased in ubiquitin in the liver of SIDS victims, ubiquitin being one of the heat-shock proteins. The correlation between ubiquitin in the brainstem and sleep apnea in SIDS was investigated here. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age, including 26 cases of SIDS. All the infants had been recorded during one night in a pediatric sleep laboratory some 3-12 weeks before death. The frequency and duration of sleep apnea were analyzed. Brainstem material was collected at autopsy and examined immunohistochemically for ubiquitin. The density of ubiquitin-positive elements was measured semiquantitatively. Correlation analyses were carried out between the density of ubiquitin-positive elements and the data on sleep apnea. RESULTS: In the victims of SIDS, a statistically significant positive correlation was found between the density of ubiquitin-positive neuronal factors in the pons and the frequency of obstructive apnea (p=0.001) and statistically significant negative correlations were seen between the density of ubiquitin-positive cells in the ependyma in the pons and the duration of obstructive apnea (p=0.044) and between the density of ubiquitin-positive cells in the subependyma in the medulla and the frequency of central apnea (p=0.024). CONCLUSIONS: It was found that three significant associations existed between the pathological data referring to ubiquitin and physiological data in SIDS victims. These facts are in agreements with the association of sleep apnea in SIDS.

Brain Stem↗
PubMed2003

The correlation between tau protein in the brainstem and sleep apnea in SIDS victims.

BACKGROUND: Recently, it has been reported that neuronal plasticity in the brainstem arousal pathway is related to the sudden infant death syndrome (SIDS). Tau protein may contribute to axonal development and neural plasticity; therefore, the correlation between tau protein in the brainstem and sleep apnea in SIDS was investigated here. MATERIALS AND METHODS: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age, including 26 cases of SIDS. The frequency and duration of sleep apnea were analyzed on all the infants, having been recorded during one night in a pediatric sleep laboratory some 3-12 weeks before death. The brainstem material was collected and immunohistochemistry of tau was carried out. The density of tau-positive elements was measured semiquantitatively. Correlation analyses were carried out between the density of tau-positive elements and the data of sleep apnea. RESULTS: In the 26 SIDS cases, tau-positive findings were observed in the sub-pia mater in two cases, in the colloid plexus in one case, in the ependyma and subependyma in five cases, in neurons in two cases and as a general diffusion in one case. In 12 control cases, tau-positive findings were observed in the sub-pia mater in one case and in neuronal elements in three cases. No correlation was found on analysis. CONCLUSIONS: There was no correlation between the finding of tau in the brainstem of SIDS victims and the incidence of sleep apnea.

Brain Stem↗
PubMed2002

From epidemiology to physiology and pathology: apnea and arousal deficient theories in sudden infant death syndrome (SIDS)--with particular reference to hypoxic brainstem gliosis.

Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age. They included 26 cases of sudden infant death syndrome (SIDS). Five infants who died from congenital cardiac abnormalities, two from infected pulmonary dysplasia, two from septic shock with multi-organ failure, one during a prolonged seizure, one from a prolonged neonatal hypoxemia, one from meningitis with brain infarction. All the infants had been recorded during one night in a pediatric sleep laboratory some 3-12 weeks before death. The frequency and duration of sleep apneas were analyzed. The infants' brain stem material was collected and immunohistochemistry of glial fibrillary acidic protein (GFAP) was carried out. The density of GFAP-positive reactive astrocytes was measured in the cardiorespiratory and arousal pathway. Akaike information criterion statistics (AIC) were calculated to elucidate the relationship between the epidemiological data on sleep position, the physiological data and the pathological data in SIDS victims. The duration of obstructive apnea was the most significant variable to differentiate between SIDS victims and control infants. In conclusion, the present study sustains the possibility of an organic fragility within the arousal pathway in SIDS victims with repetitive sleep apneas.

Brain Stem↗
PubMed2002

From physiology to pathology: arousal deficiency theory in sudden infant death syndrome (SIDS)--with reference to apoptosis and neuronal plasticity.

Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age (including 26 infant victims of sudden infant death syndrome (SIDS), 5 with congenital cardiac abnormalities, 2 from infected pulmonary dysplasia, 2 from septic shock with multi-organ failure, 1 with a prolonged seizure, 1 from prolonged neonatal hypoxemia, 1 from meningitis and brain infarction). The frequency and duration of sleep apneas recorded some 3-12 weeks before the infants' death were analyzed. Brainstem material from these 38 infants was studied in an attempt to elucidate the relationship between sleep apnea and neuronal pathological changes in the arousal pathway. Immunohistochemical analyses included the evaluation of growth-associated phosphoprotein 43 (GAP43) as a marker for synaptic plasticity. The terminal-deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method was used to identify apoptosis. The positive pathological reactions were quantitatively analyzed. The pathological and physiological data were linked for each infant. Akaike Information Criterion (AIC) statistics was calculated to elucidate the relationship between the physiological and the pathological data in the SIDS victims. The findings illustrated the possibility of an organic fragility within the arousal pathway, particularly in the midbrain periaqueductal gray matter, which is associated with the "visceral alerting response". This autonomic response occurs within an acetylcholine afferent system and pedunculopontine tegmental nucleus (PPTN). The finding is, in future SIDS infants, associated with repetitive sleep apnea.

Apoptosis↗
PubMed2002

Association between sleep apnea and reactive astrocytes in brainstems of victims of SIDS and in control infants.

Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age; 27 infants died from sudden infant death syndrome (SIDS), 5 from congenital cardiac abnormalities, 2 from infected pulmonary dysplasia, 2 from septic shock with multi-organ failure, 1 with a prolonged seizure, and another with prolonged neonatal hypoxemia. The frequency and duration of sleep apneas recorded some 3-12 weeks prior to the infants' death were analyzed. Brainstem material was retrospectively collected from these 33 infants and studied in an attempt to elucidate the relationship between sleep apnea and hypoxic gliosis. The findings were compared between the SIDS victims and the control infants. Brainstem materials were immunohistochemically studied for quantitization of reactive astrocytes using an anti-glial fibrillary acidic protein (GFAP) antibody. The pathological materials were collected within 24h of death. This study focuses on the association between respiratory characteristics and pathology. Physiological and pathological data in the arousal pathway of the brainstem were linked for each infant and variant-covariant analyses were carried out using physiological data as dependent variables and pathological data and categorical data to evaluate the association with SIDS or non-SIDS as independent variables. The study failed to statistically support an association between hypoxic loads, reflected by the GFAP-positive reactive astrocytes in brainstems, the classification of being SIDS or non-SIDS infants, and the characteristics of sleep apnea.

Analysis of Variance↗
PubMed2002

Interaction between apnea, prone sleep position and gliosis in the brainstems of victims of SIDS.

Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died suddenly and unexpectedly under 6 months of age. Of these, 26 died from sudden infant death syndrome (SIDS), 5 from congenital cardiac abnormalities, 2 from infected pulmonary dysplasia, 2 from septic shock with multi-organ failure, 1 from a prolonged seizure, 1 from prolonged neonatal hypoxemia, and 1 from meningitis and brain infarction. The frequency and duration of apneas recorded some 3-12 weeks prior to the infants' death were analyzed. The brainstem materials were collected and studied in an attempt to elucidate the relationship between sleep apnea, and prone sleep position and gliosis in some nuclei associated with cardiorespiratory characteristics, such as nucleus ambiguus in the medulla oblongata and the solitary nucleus, as well as structures associated with arousal phenomenon, such as the reticular formation, the superior central nucleus and the nucleus raphe magnus in the pons, the dorsal raphe nuclei in the midbrain and medulla oblongata, periaqueductal gray matter in midbrain, and locus ceruleus. Gliosis was estimated as the density of glial fibrillary acidic protein (GFAP)-positive reactive astrocytes. Variant-covariant analyses were carried out using the characteristics of apnea as an independent variable and sleep position and gliosis as dependent variables. A significant association was found only in the frequency of obstructive apnea and prone position (P<0.001) and gliosis in the raphe nuclei in the midbrain (P<0.001). Although prone position is a well-known risk factor for SIDS, the frequency of obstructive apnea has not been associated with the prone sleep position. The observed relation between prone sleep and the density of gliosis does not relate to epidemiological findings. Further studies are needed to investigate the unexpected statistical association.

Analysis of Variance↗
PubMed2002

Arousal deficiency theory in sudden infant death syndrome with reference to neuronal plasticity.

OBJECTIVE: Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died under 6 months of age (including 26 infant victims of sudden infant death syndrome (SIDS), five with congenital cardiac abnormalities, two from infected pulmonary dysplasia, two from septic shock with multi-organ failure, one with a prolonged seizure, one from prolonged neonatal hypoxemia and one from meningitis and brain infarction). METHOD: The frequency and duration of sleep apnea events recorded some 3-12 weeks before the infants' deaths were analyzed. Brainstem material from these 38 infants was studied in an attempt to elucidate the relationship between sleep apnea and neuronal pathological changes in the arousal pathway. The histochemical analyses included Bielschowsky staining and the immunohistochemical analyses included the evaluation of growth-associated phosphoprotein 43 (GAP43) and of synaptophysin as markers for synaptic plasticity. Neurofibrae with positive pathological reactions were quantitatively analyzed. Pathological and physiological data were linked for each infant. RESULTS: The correlation between sleep apnea and neuronal plasticity in the arousal pathway of the SIDS victims was not seen in the control infants and the correlation between sleep apnea and neuronal plasticity in the arousal pathway found in the control infants was not seen in the SIDS victims. CONCLUSION: These findings suggest that neuronal plasticity in the brainstem arousal pathway is related with SIDS.

Journal Article↗
PubMedDate not supplied

Infant sleep positioning by nursery staff and mothers in newborn hospital nurseries.

BACKGROUND: Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk, literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited. OBJECTIVE: To assess newborn placement practices of the mother and nursery staff and their interrelationship in the hospital setting. METHODS: A cross-sectional survey-based study was conducted among hospital newborn nursery staff (n = 96) and mothers of newborns (n = 579) at eight perinatal hospitals in Orange County, California. RESULTS: Although a majority of sampled nursery staff (72%) identified the supine position as the placement that most lowers sudden infant death syndrome risk, only 30% reported most often placing infants to sleep in that position, with most staff (91%) citing fear of aspiration as the motivation for supine position avoidance. Only 34% of staff reported advising exclusive supine infant positioning to mothers. Approximately 36% of mothers reported using supine infant placement exclusively. Maternal infant placement choice varied by both the advice (p <.01) and the placement modeling (p <.01) provided by staff, with the highest proportion of usual supine infant placement found among mothers who reported receiving both. A mother's race/ethnicity also affected the reception of exclusive supine placement recommendations (p <.01). CONCLUSIONS: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants. Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated.

Adult↗
PubMed1992

The impact of postnatal depression on infant development.

A large sample of primiparous women was screened for depression after childbirth. Those identified as depressed, women with a previous history of depression and a control group were followed up to 18 months, when their infants were assessed on measures of cognitive, social and behavioral development. Infants of postnatally depressed mothers performed worse on object concept tasks, were more insecurely attached to their mothers and showed more mild behavioural difficulties. Postnatal depression had no effect on general cognitive and language development, but appeared to make infants more vulnerable to adverse effects of lower social class and male gender.

Child↗
PubMed1994

Maternal attitudes as predictors of infant feeding decisions.

To achieve the goal of Healthy People 2000 of increasing the rate and duration of breast-feeding in the United States, it is important to determine how maternal attitudes influence choice of infant feeding method. This study of postpartum women explores the extent to which maternal attitudes concerning process (how the baby is fed) and product (what the baby is fed) can predict the method of infant feeding during the hospital stay. A cross-sectional analysis of mothers' attitudes and infant feeding behavior was conducted. The participants included 216 mothers of infants less than 48 hours of age. Sociodemographic characteristics and maternal attitudes were analyzed to determine their ability to predict choice of feeding method. The results of the study indicate that maternal attitudes are better predictors of feeding method than are sociodemographic factors. These attitudinal variables, reflecting concerns over food intake, infant nutrition, and parental role, were most strongly related to choice of infant feeding method. The study indicates that maternal attitudes concerning the process and product dimensions of infant feeding provide valuable information regarding the women most likely to select either breast-feeding or formula-feeding. To increase the rate of breast-feeding, interventions should be developed that are consonant with positive maternal attitudes concerning the process and product dimensions of breast-feeding.

Adolescent↗
PubMed1984

Social support of teenage mothers.

The purpose of this paper is to report the social support perceived as available by teenage mothers during their first year of motherhood and the correlation of perceived social support with maternal role attainment variables. Social support was one of 11 independent variables studied for their impact on the maternal role for three age groups of first-time mothers: 15-19, 20-29, and 30-42 years. Social support described was categorized into four types--informational, emotional, physical, and appraisal--and by the network size. Sixty-six teenagers agreed to participate in the study, and they were interviewed in the hospital during early postpartum and in their homes or a setting of their choice at 1,4,8, and 12 months after birth. This highly mobile population was difficult to follow, and there was a subject loss over the year of 39.4% (N = 26). During early postpartum, the only type of support to correlate with maternal attachment (one of the two maternal role attainment variables measured at that time) was informational support, and teenagers had received significantly less than older women. There were no significant correlations of any of the support variables with the teenagers' perceptions of their neonate, the second measure of maternal role attainment. Teenagers received less emotional support from mates and from parents than older women. At 1 month postpartum, teenagers received less emotional support than older mothers, but reported more informational support. Support variables failed to correlate with maternal role attainment measures of perceptions of the neonate, ways of handling irritating child behaviors, or infants' growth and development. Physical and emotional support correlated positively with feelings of love for the infant, and informational and emotional support correlated positively with gratification in the mothering role. Physical support correlated positively with maternal competency behaviors. At 4 months after birth, teenagers continued to receive less emotional support than older mothers, but there were no differences in other types of support received. Physical support correlated positively with maternal gratification in the role, infants' growth and development, and maternal competency behaviors. Other types of support and the size of the network did not correlate with any of the maternal role attainment variables. Teenagers continued to receive less emotional support than older mothers at 8 months after birth, although there were no differences in other types of support received. The support variables failed to correlate significantly with any of the five maternal role attainment variables at this time.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed2002

Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants.

The effects of variations in carbohydrate and fat intake and body position on behavioral activity states were evaluated in 64 healthy, growing low birth weight infants (birth weight, 750-1600 g). The infants, enrolled in a prospective, randomized, double-blind, controlled study of effects of quality of dietary energy, were fed one of the five formulas. These formulas contained fixed intakes of protein (4 g/kg per day) but different intakes of carbohydrate (9.1 to 20.4 g/kg per day) and fat (4.3 to 9.5 g/kg per day). Six-hour daytime sleep studies were performed at 2-wk intervals from time of full enteral intake until discharge (mean postconceptional age at first study, 33.2 +/- 1.8 wk). Infants were randomly assigned to the prone or supine position for the first 3-h postprandial period; the position was reversed during the second 3 h. Behavioral activity state, i.e. quiet sleep (QS), active sleep, indeterminate sleep, awake, or crying was coded each minute throughout the postprandial period. The overall incidence of QS was almost double in the prone position versus the supine (p < 0.0001). In contrast, the probability of being in either of the two wakeful states (awake and crying) was increased when infants were placed in supine position (p < 0.0001). Increased likelihood of being in QS while prone was found only during the 30 min after and before feeding in a 150-min prandial cycle. In contrast, increased amounts of awake and crying in supine position were observed throughout the feeding interval. As carbohydrate intake increased, time spent in QS in supine position increased (from 8.6% to 12.5%, p < 0.02), and a trend in the same direction was noted for the prone position (p = 0.06). However, during postprandial minutes 10-100, when QS is likely to be entrained by the nutrient intake, enhancement of QS was found in the prone position only (p < 0.02). Carbohydrate intake influences the total time spent and the distribution of behavioral activity states within the postprandial period in low birth weight infants. The effect of nutrient intake on sleep profile is dependent on body position and time after feed. Mechanistic hypotheses relating sudden infant death syndrome to sleeping position may need to take these observations into account.

Dietary Carbohydrates↗