ABSTRACT
OBJECTIVE: Thresholds of cerebral hypoxia through monitoring of near-infrared spectroscopy tissue oxygenation index (TOI) were used to investigate the relationship between intraventricular haemorrhage (IVH) and indices of hypoxia. DESIGN: Prospective observational study. SETTING: A single-centre neonatal intensive care unit. PATIENTS: Infants <28 weeks' gestation with an umbilical artery catheter. METHODS: Thresholds of hypoxia were determined from mean values of TOI using sequential Χ2 tests and used alongside thresholds from existing literature to calculate percentage of time in hypoxia and burden of hypoxia below each threshold. These indices were then compared between IVH groups. RESULTS: 44 infants were studied for a median of 18.5 (range 6-21) hours in the first 24 hours of life. Sequential Χ2 analysis yielded a TOI threshold of 71% to differentiate between IVH (16 infants) and no IVH (28 infants). Percentage of time in hypoxia was significantly higher in infants with IVH than those without, using thresholds of 60%-67%. Burden of hypoxia was significantly higher in infants with IVH than without, using thresholds of 62%-80%. With the threshold of 71%, percentage of time in hypoxia was lower by 12.2% with a 95% CI of (-25.7 to 1.2) (p=0.073), and the burden of hypoxia was lower by 29.2% hour (%h) (95% CI -55.2 to -3.1)%h (p=0.012) in infants without IVH than those with IVH. CONCLUSIONS: Using defined TOI thresholds, infants with IVH spent higher percentage of time in hypoxia with higher burden of cerebral hypoxia than those without, in the first 24 hours of life.
Subject(s)
Cerebral Hemorrhage/epidemiology , Hypoxia, Brain/epidemiology , Infant, Premature, Diseases/epidemiology , Catheterization , Cerebral Hemorrhage/physiopathology , Cerebrovascular Circulation/physiology , Female , Gestational Age , Humans , Hypoxia, Brain/physiopathology , Infant, Newborn , Infant, Premature, Diseases/physiopathology , Intensive Care Units, Neonatal , Male , Prospective Studies , Spectroscopy, Near-Infrared , Umbilical ArteriesABSTRACT
OBJECTIVE: Despite evidence that excessive screen use may contribute to negative health, developmental, emotional, and behavioral outcomes, more children are engaging in increasing amounts of screen-related activities. For children with neurodevelopmental conditions, increased screen use could exacerbate emotional/behavioral difficulties (EBDs) by interfering with sleep quantity and quality. AIMS: This study examined the possible mediating role of sleep in the relationship between screen use and EBDs in preschool children with neurodevelopmental disorders (NDDs) clinically referred to a child development center in Singapore. METHODS: A screen use questionnaire developed for the purposes of the present study, the Children's Sleep Habits Questionnaire, and the Strengths and Difficulties Questionnaire were completed by 367 caregivers of 2- to 5-year-old children with NDDs (39.5% autism spectrum disorder; 36.8% speech-language disorders; 23.7% others). RESULTS: Average daily screen use duration was 3.98 hours, with 93.9% exceeding 1 hour of screen time daily. 57.7% of children had screen devices in their bedrooms, while 52% commenced screen use at the age of 18 months or earlier. Sleep problems fully mediated the relationship between the number of bedroom screen devices and children's EBDs, as well as between the age of first screen use and EBDs, but not between hours of screen use and EBDs. Controlling for age, developmental level, and family income, children who started using screens earlier than 18 months and who had screen devices in their bedrooms had significantly more sleep problems and EBDs than those without. CONCLUSION: Children with neurodevelopmental conditions may have more difficulties disengaging from screen devices in their bedrooms, and an earlier age of screen exposure may contribute to more chronic disruption of sleep.
