Sleep in the Neonatal Intensive Care Unit

Abstract

Recent experimental data suggest a strong role for sleep in brain development. As sleep is the predominant behavioral state in the term and especially the preterm newborn, these data underline the importance of respecting sleep duration and organization within the different sleep states. Polysomnography is the preferred technique used for identification of sleep state; however, behavioral observations-under the condition that the observer is well trained-may prove as efficient. Newborns hospitalized in the neonatal intensive care unit are exposed to many stimuli and care activities that disrupt their sleep organization and may have irreversible effects on their brain development. In order to improve the long-term neurobehavioral outcome of these high-risk subjects, a consistent care approach is proposed. Application of the Neonatal Individualized Developmental Care and Assessment Program decreases environmental stressful events and promotes harmonious well-being behaviors, based on an individual approach. This strategy has encouraging results, showing an increase in sleep duration under Neonatal Individualized Developmental Care and Assessment Program conditions, but further studies are needed to assess its long-term neurobehavioral impact.

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

“…The data from observations allowed us to infer that the total sleep time was lower in the absence of environment management due to handling of newborns by unit staff and cry arising from care, which may have boosted the increase in the noise level and the consequent environmental acoustics change in general. This result also indicates that premature infants are being deprived of sleep, which can cause various deleterious effects such as stress, irritability, increased heart rate, basal metabolism with consequent weight loss, increased susceptibility to infections and changes in pain perception (14,18,20) . Sleep deprivation may be related to the impairment of sick children, generating an increase in hospitalization costs and delaying hospital discharge (20) .…”

“…Researches that aimed to assess the impact of environmental management on sleep of hospitalized premature infants using the polysomnograph in two periods of 180 minutes, found a 20% increase in total sleep time when covered the incubators to reduce the incidence of light and also when kept room door closed in order to minimize noise (7,14) . Although nap time proposed by the NICU have been effective in promoting sleep of those premature infants investigated, the results allow concluding that in the remaining 20 hours there was no environmental management, total sleep time was only 11.6 hours.…”

“…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 reducing stress to hospitalized newborns, recommending actions in order to minimize the impact of the various deleterious effects caused by the environment and care for newborns (2,5,14) . Among the strategies recommended by the developmental care, there is the management of the neonatal unit environment, which is characterized by reduced sensory and environmental stimuli to newborns.…”

Caregiving and positioning effects on preterm infant states over 24 hours in a neonatal unit in Taiwan

“…The mean sleep cycle duration has been observed to be about 40 minutes at 27-30 weeks gestational age (GA), 45 minutes at 31-34 weeks GA, and 50-70 minutes at 35-41 weeks GA (Bertelle, Sevestre, Laou-Hap, Nagahapitiye, & Sizun, 2007). Increasing GA also was found to be correlated with increased QS and decreased AS (Holditch-Davis et al, 2004;Ingersoll & Thoman, 1999).…”

A Case Study of the Environmental Experience of a Hospitalized Newborn Infant With Complex Congenital Heart Disease

“…These extensive sleep interruptions might be attributed to the considerable levels of environmental stimulation experienced from noise, light, and patient care and could adversely impact the development of circadian rhythms. 37 Sleep is a vital necessity for brain development and healing, especially for infants, who spend most of their first year of life in the state of sleeping. 37,38 In an intensive care unit setting, patients with compromised health conditions find that the required level of sleep is especially elusive with unintentional yet repeated disruptions from noise, lighting, and intensive medical and nursing care.…”