Effects of eye cover among high risk neonates at night shift on their distress levels

Abstract

Background and aim: The Neonatal Intensive Care Unit (NICU) is a stressful environment for high risk neonates. Persistent bright light is one of the main environmental stressors that are distressed newborn infants in NICU. Cycled lighting may decrease distress level of newborn infants by enhancing calming status. This study aimed to investigate effects of eye cover among high risk neonates at night shift on their distress levels.Methods: Quasi experimental research design was carried out on a randomized sample of 60 newborn infants attending the NICU of El Manial University Hospital (Kasr Al Ainy), (30 control group and 30 study group). Neonatal assessment tool and COMFORTneoNRS scale were utilized for data collection.Results: There was a statistically significant difference between control and study groups regarding the distress levels (p < .00). The mean score of distress levels were 6.80 ± 1.80 and 0.80 ± 1.15 respectively and the mean score of comfort levels in the newborn infants in the control and study groups were 23.22 ± 5.50 and 6.60 ± 1.06 respectively. Eye coved enhanced quite sleep (66.7%), relaxed muscle (73.3%), decrease movement (66.7%) and no crying (85.7%).Conclusions: The use of eye cover among high risk neonates at night shift is effective to decrease their distress level and improve their comfort state in the morning shift by promoting quite sleep and relaxation. Recommendations: The educational program is needed to raise awareness among neonatal nurses about the effect of light reduction methods such as eye patches on the distress level and comfort state that enhances the growth and development of newborn infants.

Beginning to See the Light: Lessons Learned From the Development of the Circadian System for Optimizing Light Conditions in the Neonatal Intensive Care Unit

“…However, it should be noted that other studies did not find an effect of cycled light on hospitalization duration (Mann et al, 1986;Farahani et al, 2018;Moselhi Mater et al, 2019). Cycled light interventions in the NICU have also been reported to increase nighttime sleep duration (Guyer et al, 2015) and the ratio of daytime to nighttime activity (Blackburn and Patteson, 1991;Watanabe et al, 2013), to reduce or stabilize heart rate patterns (Blackburn and Patteson, 1991;Vásquez-Ruiz et al, 2014), and lower distress levels compared to continuous light (Moselhi Mater et al, 2019). Interestingly, one study reported a difference in morning and evening melatonin levels in infants exposed to cycled light but not in infants exposed to continuous light (Vásquez-Ruiz et al, 2014), suggesting that implementing a light-dark cycle promotes circadian entrainment.…”

“…Another study found an effect of similar magnitude on hospitalization period (59 ± 28 days in the cycled light group vs 75 ± 25 days in the continuous light group), although this difference was not statistically significant (Miller et al, 1995). However, it should be noted that other studies did not find an effect of cycled light on hospitalization duration (Mann et al, 1986;Farahani et al, 2018;Moselhi Mater et al, 2019). Cycled light interventions in the NICU have also been reported to increase nighttime sleep duration (Guyer et al, 2015) and the ratio of daytime to nighttime activity (Blackburn and Patteson, 1991;Watanabe et al, 2013), to reduce or stabilize heart rate patterns (Blackburn and Patteson, 1991;Vásquez-Ruiz et al, 2014), and lower distress levels compared to continuous light (Moselhi Mater et al, 2019).…”

Effects of the neonatal intensive care environment on circadian health and development of preterm infants

“…However, they do not address (cycled) light exposure in their approach. Although preclinical and clinical evidence suggests that reducing light exposure during the night leads to improved psychomotor development and sleep patterns, increased stability of the autonomic nervous system, faster weight gain, shorter NICU stay, and reduced stress in newborns, implementation in the NICU is difficult ( Guyer et al, 2012 ; Vasquez-Ruiz et al, 2014 ; Moselhi Mater et al, 2019 ). This is most likely because well-designed randomized controlled trials are lacking and exposure to high-intensity lightning is known to increase stress and induce physiological changes ( Ozawa et al, 2010 ).…”

“…Since the Cochrane review in 2016, four new studies on light-cycling in the NICU have been published. Two focused on CL versus CBL ( Farahani et al, 2018 ; Moselhi Mater et al, 2019 ). Moselhi Mater et al (2019) used eye covers versus “normal NICU lighting.” They showed that the use of eye covers at night reduced distress levels ( p < 0.00) and enhanced quiet sleep, muscle tension and reduced crying ( Moselhi Mater et al, 2019 ).…”

“…Two focused on CL versus CBL ( Farahani et al, 2018 ; Moselhi Mater et al, 2019 ). Moselhi Mater et al (2019) used eye covers versus “normal NICU lighting.” They showed that the use of eye covers at night reduced distress levels ( p < 0.00) and enhanced quiet sleep, muscle tension and reduced crying ( Moselhi Mater et al, 2019 ). The other study, comparing CL and CBL, found a non-significant decrease in hospitalization length and a significant increase in daily weight gain in the CL group ( Farahani et al, 2018 ).…”