Impact of hands-on care on infant sleep in the neonatal intensive care unit

Abstract

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.

O efeito da manipulação sobre o sono do recém-nascido prematuro

“…This indicates a direct relationship between handling frequency and sleep and respiratory events. (12) Studies have found that excessive handling and sleep deprivation in preterm infants may impair neuromotor development, induce hyperexcitability, trigger or exacerbate psychiatric diseases, and cause excessive daytime sleepiness. (1,(13)(14)(15) Furthermore, sleep is the main behavioral state of preterm infants and constitutes an important basic need.…”

Effects of a supportive care bundle on sleep variables of preterm infants during hospitalization

“…Several supportive interventions have been shown to help stabilize infants and preserve sleep. Sleep integrity can be preserved by modifying the NICU environment to reduce noise and light levels (Varvara, Effrossine, Despoina, Konstantinos, & Matziou, ) and adjusting caregiving activities (Levy et al, ). Increased sleep time for infants can be immediately achieved with gentle touch (Bahman Bijari, Iranmanesh, Eshghi, & Baneshi, ), a prone position (Modesto et al, ), holding an infant in a flexed position, known as facilitated tucking (Valizadeh, Ghahremani, Gharehbaghi, & Jafarabadi, ), non‐nutritive sucking on a pacifier (sucking; Liaw et al, ), nesting, and swaddling (Abdeyazdan, Mohammadian‐Ghahfarokhi, Ghazavi, & Mohammadizadeh, ).…”

“…Preterm infants' sleep in the NICU frequently is disrupted and fragmented (Levy et al, 2017). Sleep is a crucial human physiological need, which is beneficial to the maturation of the central nervous system (Peigneux, Fogel, & Smith, 2017), memory consolidation, secretion of growth hormone (Bonan et al, 2015), energy storage, and illness recovery (Mahmoodi, Arbabisarjou, Rezaeipoor, & Pishkar Mofrad, 2016).…”

“…The chaotic environment of the NICU can interfere with infants' ability to modulate their sleep-wake states (Als, 1986). Preterm infants need caregivers' assistance in regulating their sleep-wake states, by reducing environmental stress and adjusting nursing care activities (Als, 1986 (Levy et al, 2017). Increased sleep time for infants can be immediately achieved with gentle touch (Bahman Bijari, Iranmanesh, Eshghi, & Baneshi, 2012), a prone position (Modesto et al, 2016), holding an infant in a flexed position, known as facilitated tucking (Valizadeh, Ghahremani, Gharehbaghi, & Jafarabadi, 2016), non-nutritive sucking on a pacifier (sucking; Liaw et al, 2012), nesting, and swaddling (Abdeyazdan, Mohammadian-Ghahfarokhi, Ghazavi, & Mohammadizadeh, 2016).…”

Pediatric Pulmonologyyear in review 2016: Part 1

“…The importance of sleep and the consequences of sleep disruption have received increasing attention . Levy et al studied sleep disruption in 25 term and near term infants hospitalized in a neonatal intensive care unit. Infants underwent bedside PSG.…”