Summary Study Objectives Sleep disruption is increasingly recognized in hospitalized patients. Impaired sleep is associated with measureable alterations in neurodevelopment. The neonatal intensive care unit (NICU) environment has the potential to affect sleep quality and quantity. We aimed: (i) to determine the frequency and duration of hands-on care, and its impact on sleep, for NICU patients; and (ii) to assess the incidence of respiratory events associated with handling for a cohort of sick neonates. Methods Term and near-term neonates admitted to the NICU and at risk for cerebral dysfunction due to severity of illness or clinical suspicion for seizures underwent attended, bedside polysomnography. Continuous polysomnogram segments were analyzed and data on handling, infant behavioral state, and associated respiratory events were recorded. Results Video and polysomnography data were evaluated for 25 infants (gestational age 39.4 ± 1.6 weeks). The maximum duration between handling episodes for each infant was 50.9 ± 26.2 min, with a median of 2.3 min between contacts. Handling occurred across all behavioral states (active sleep 29.5%; quiet sleep 23.1%; awake 29.9%; indeterminate 17.4%; P = 0.99). Arousals or awakenings occurred in 57% of contacts with a sleeping infant. Hypopnea, apnea, and oxygen desaturation occurred with 16%, 8%, and 19.5% of contacts, respectively. Hypopnea was most likely to occur following contact with infants in active sleep (28%; P < 0.001). Conclusions Infants in the NICU experience frequent hands-on care, associated with disturbances of sleep and respiration. The potential health and developmental impact of these disturbances merits study, as strategies to monitor sleep and minimize sleep-disordered breathing might then improve NICU outcomes.

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Premature infants with respiratory distress oxygenate better and have improved breathing synchrony when they are nursed in the prone position. We investigated whether work of breathing (WOB) is decreased in the prone position in healthy premature infants nearing discharge from the neonatal intensive care unit. Nineteen convalescing premature infants in room air were studied in both supine and prone position. Positioning order was randomized. Mean birth weight was 1358 +/- 332 (SD) g, gestational age 29.7 +/- 2.1 weeks, weight at study 1757 +/- 248 g, and age at study 33.6 +/- 1.4 days. Calibrated respiratory inductance plethysmography (RIP) was used to measure tidal volume; an esophageal catheter estimated pleural pressure. Inspiratory, elastic, and resistive WOB were calculated and were unaffected by prone versus supine positioning (P = 0.46, 0.36, and 0.87, respectively). Similarly, respiratory rate, tidal volume, minute ventilation, and lung compliance did not differ between positions. These data suggest that sleep position recommendations for healthy premature infants discharged home without oxygen should be no different than for term infants.

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