Integrated assessment of sleep-cycle maturation in preterm infants during extra-uterine third trimester - sleep disturbances due to the stressful neonatal intensive care unit (nicu) environment may be…

The National Institute of Child Health and Human Development awarded Children's Research Institute $500,500 on September 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.HDR) to conduct a prospective observational study integrating bedside sleep monitoring tools for preterm infants during the neonatal intensive care unit (NICU) stay.

The research addresses sleep-cycle maturation in preterm infants born during the extrauterine third trimester. Sleep disturbances in the NICU environment may serve as a modifiable risk factor for cognitive-behavioral deficits in prematurely born children. The study will use quantitative analysis of heart rate and respiratory rate variability derived from electrocardiogram and pulse oximetry—tools already routinely acquired at the NICU bedside—to identify sleep states (awake, active sleep, quiet sleep, and transitional sleep) in real time. The investigators will enroll 60 preterm infants and compare the agreement between bedside-accessible physiologic measures and benchmark sleep assessment tools (video-electroencephalography and polysomnography) to develop a pragmatic, non-invasive classification model. Characterizing longitudinal sleep-cycle maturation may provide early biomarkers of brain maturation with prognostic value for cognitive outcomes in childhood.

The performance period runs from September 1, 2026, through August 31, 2028, with work performed in Washington, DC. Children's Research Institute, a tax-exempt pediatric research organization and research subsidiary of Children's National Medical Center, serves as the recipient.

Integrated assessment of sleep-cycle maturation in preterm infants during extra-uterine third trimester - sleep disturbances due to the stressful neonatal intensive care unit (nicu) environment may be a modifiable risk factor for the 4-fold higher odds of cognitive-behavioral deficits in prematurely born children. Although nicu caregivers acknowledge the importance of sleep, they face challenges in synchronizing the nicu environment with the short and often indeterminate sleep cycles. There is a critical need for reliable and non-invasive bedside sleep monitoring tools to differentiate infant's awake and sleep (active, quiet, and transitional) states in real time during the third trimester. Further, characterizing the longitudinal sleep cycle maturation over the third trimester may provide early biomarkers of brain maturation with prognostic value for cognitive outcomes later in childhood. Bedside observation-based behavioral sleep stage classification for preterm infants (besspi)42 has been validated recently for preterm infants. The benchmark sleep assessment tools polysomnography (PSG) and video-electroencephalography (EEG) need multiple additional sensors (scalp EEG leads and airway sensors) and complex analysis not amenable at the nicu bedside. We have performed quantitative analyses of heart rate and respiratory rate variability (electrocardiogram [EKG] and pulse oximetry) and observed strong agreement with besspi for delineating sleep states during the third trimester. We propose a prospective observational study using a pragmatic approach to integrate tools routinely acquired at the bedside for nicu care and identify the model that yields best agreement with the benchmark of veeg and PSG. We will enroll 60 preterm infants (born