Repeated procedural pain can cause preterm infants to spend excessive time awake at the cost of sleep and can have a detrimental impact on later cognitive and behavioral development. What's more, poor sleep may be correlated with worse cognitive development and more internalizing behaviors in infants and toddlers. In a randomized controlled trial (RCT), we found that combined procedural pain interventions (sucrose, massage, music, nonnutritive sucking, and gentle human touch) during neonatal intensive care could improve preterm infants' early neurobehavioral development. Here, we followed up the participants who were enrolled in the RCT to evaluate the effect of combined pain interventions on later sleep, cognitive development, and internalizing behavior and to determine whether sleep may moderate the effect of combined pain interventions on the cognitive development and internalizing behavior. Total sleep time and night awakenings at 3, 6, and 12 months old; the cognitive development (adaptability, gross motor, fine motor, language, and personal-social domains) at 12 and 24 months old measured by the Chinese version of Gesell Development Scale; and the internalizing behavior at 24 months old measured by the Chinese version of Child Behavior Checklist were assessed. Our findings showed the potential benefits of combined pain interventions during neonatal intensive care for preterm infant's later sleep, motor and language development, and internalizing behavior, and the effect of combined pain interventions on motor development and internalizing behavior might be moderated by the mean total sleep duration and night awakenings at 3, 6, and 12 months old.

中文翻译：

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新生儿重症监护期间联合程序性疼痛干预对睡眠、认知发展和内化行为的影响：随机对照试验的后续分析。

反复的手术疼痛可能会导致早产儿长时间处于清醒状态，从而影响睡眠，并对以后的认知和行为发育产生不利影响。更重要的是，睡眠不佳可能与婴儿和幼儿的认知发展较差和内化行为较多有关。在一项随机对照试验 (RCT) 中，我们发现在新生儿重症监护期间结合程序性疼痛干预措施（蔗糖、按摩、音乐、非营养性吸吮和轻柔的人体触摸）可以改善早产儿的早期神经行为发育。在这里，我们对参加随机对照试验的参与者进行了随访，以评估联合疼痛干预措施对后期睡眠、认知发展、和内化行为，并确定睡眠是否可以减轻联合疼痛干预对认知发展和内化行为的影响。3、6 和 12 个月大时的总睡眠时间和夜间醒来次数；采用中文版格塞尔发展量表测量 12 个月和 24 个月大的认知发展（适应性、粗大运动、精细运动、语言和个人社交领域）；并评估24个月大时用中文版《儿童行为量表》测量的内化行为。我们的研究结果表明，在新生儿重症监护期间联合疼痛干预对于早产儿后期睡眠、运动和语言发育以及内化行为具有潜在益处，