Effect of reducing sensory and environmental stimuli during hospitalized premature infant sleep

Abstract

Objective:To compare the total sleep time of premature infant in the presence or absence of reducing sensory and environmental stimuli in the neonatal unit. Method: Longitudinal study in a Neonatal Intermediate Care Unit of a public hospital in Sao Paulo. The sample consisted of 13 premature infants. We used polysomnograph and unstructured observation for data collection. We analyzed 240 and 1200 minutes corresponding to the periods of the presence and absence of environmental management, respectively. Data were compared in proportion to the total sleep time in the two moments proposed by the study. Results: The total sleep time in periods without environmental management was on average 696.4 (± 112.1) minutes and with management 168.5 (± 27.9) minutes, proportionally premature infant slept an average of 70.2% during periods with no intervention and 58.0% without management (p=0.002). Conclusion: Reducing stimulation and handling of premature infant environment periods was effective to provide greater total sleep time. DESCRIPTORS INTRODUCTIONThe estimate of premature births in Brazil is about 9.8% of the 2,913.160 births registered in 2011 (1) . Due to prematurity, the proportion of premature infants (PI) may require hospitalization in a neonatal unit, which is commonly characterized as in environment that has high sensory stimuli overload for the newborn, additionally, there is a need for frequent management for invasive and painful procedures (2)(3)(4)(5) . The characteristics of the neonatal unit environment and care provided to premature infants according to the institutional routines can reduce the total sleep time leading them to consequent deprivation, which can be constituted in morbidity factor, especially when the gestational age is low and the length of hospital stay is long (2,4,6) . Many studies show that sleep deprivation of premature infants in the neonatal unit can lead to worsening of clinical status and delay hospital discharge, besides that, it could trigger behavioral disorders in adulthood (4,(7)(8) . PI present sleep with polyphasic pattern that are classified into three stages: active, quiet and indeterminate sleep (3,7,(9)(10) . The different stages of sleep are essential for the homeostasis of premature infants, because they establish relations with important physiological and neurological activities (3,9) . In the quiet sleep, decreased basal metabolic rate occurs, which promotes replenishment of energy reserves as well as promote cellular repair, in the active sleep brain activation occurs, which is essential for the structural maturation of the central nervous system (10)(11) . It is noteworthy that the indeterminate sleep cannot be considered as quiet or active, it is characterized as the transition between these two types of sleep patterns (12) . Mitigating possible harmful effects of care provided to hospitalized newborns is one of the actions that should be prioritized by professionals working towards recovery (13) . In this context, the developmental care aims at reduc...

Effectiveness of Hammock Positioning in Reducing Pain and Improving Sleep-Wakefulness State in Preterm Infants

“…21 Sleep deprivation in preterm infants in neonatal ICUs may worsen the clinical status of these infants and delay discharge from hospital. 22 The observations described above corroborate the results of the present study, in which the preterm infants placed in hammocks had an improvement of 6, 4, and 3.5% in heart rate, breathing frequency, and S pO 2 , respectively.…”

Developmental Care: assistance of nurses from Neonatal Intensive Care Units

“…A national study endorsed the care protocol regarding the adoption of NB sleep schedules in NICU, with maximum handling minimization, since the practice generated an increase in the total NB sleep time, especially in quiet sleep, as opposed to the care periods in NICU, which is not adopted the same (2) . Articulating sleep and other issues, it is highlighted in the literature that the CM contributes with hours of sleep (15)(16) , as well as enlarges the interactions between the NB and the one that is in contact with skin and skin with it and maintains the same in positioning physiologically adequate (16) .…”

“…In 2011, about 9.8% of the 2,913,160 births registered in Brazil were premature (1) . These Newborns (NB), due to prematurity, are usually referred to the Neonatal Intensive Care Unit (NICU) (2) . Endowed with high technology and a massive supply of care, the NICU has a dual character since it favors clinical stability and survival (2) of premature newborns, while at the same time subjecting them to damages (3)(4) .…”

“…These Newborns (NB), due to prematurity, are usually referred to the Neonatal Intensive Care Unit (NICU) (2) . Endowed with high technology and a massive supply of care, the NICU has a dual character since it favors clinical stability and survival (2) of premature newborns, while at the same time subjecting them to damages (3)(4) . One of the factors that makes them vulnerable is their insufficient capacity for selfregulation, due to the high sensorial loads experienced in this context (3) , mainly due to the effects of interventions performed without adequate measures of pain management (5) , luminosity and noise, allied to care protocols that disregard sleep and rest issues, generating stress and discomfort to the premature.…”

“…One of the factors that makes them vulnerable is their insufficient capacity for selfregulation, due to the high sensorial loads experienced in this context (3) , mainly due to the effects of interventions performed without adequate measures of pain management (5) , luminosity and noise, allied to care protocols that disregard sleep and rest issues, generating stress and discomfort to the premature. Such context may imply an increased risk of abnormal brain maturation (4) and constitutes a morbidity factor (2) .…”