Behavior and EEG concordance of active and quiet sleep in preterm very low birth weight and full-term neonates at matched conceptional age

• Sleep organization in neonates is an established predictor of neurological outcome.
• Concordance between sleep stages and behavioral states increase with gestational age.
• Concordance is lower in quiet sleep when compared to active sleep

BackgroundSleep organization in neonates is an established predictor of neurological outcome and can be evaluated through the concordance between EEG and behavioral parameters.AimsTo evaluate the correlation between sleep stages and behavioral states in neonates.Study designLongitudinal study performed in a birth-cohort of preterm low birth weight neonates.SubjectsTwenty five neonates, 15 preterm (gestational age between 27 and 33 weeks) and low birth weight (800–1500 g) and 10 full-term neonates that served as controls.MeasuresAll neonates were submitted to video-electroencephalography of, at least, 60 minute duration. The preterm during the first 15 days of life and, subsequently, at 38–42 weeks of conceptional age. The full-term between the 1st and 2nd days of life. The characterization of sleep stages by EEG parameters and behavioral states (based on Prechtl scale) was performed independently by previously trained researchers.ResultsActive sleep (AS) was the predominant sleep stage in the three groups. Preterm neonates had an increase in concordance between state 1 and quiet sleep (QS) from the 1st to the 2nd EEG (p < 0.001), however in both observations it remained inferior when compared to state 2 and AS (p < 0.001). Concordance between AS and state 2 was similar (p = 0.567).ConclusionsConcordance between EEG and behavior is lower in QS in preterm and full-term neonates when compared to AS. Extra-uterine development of preterm neonates seems to accelerate concordance in QS. Prechtl behavior scale proved to be useful in preterm as percentage of concordance was similar in AS in the groups studied.