Observational study found that even small variations in light can wake up very preterm infants in a neonatal intensive care unit

Review of Cycled Lighting's Effect on Premature Infants' Circadian Rhythm Development and Clinical Outcomes Based on Gestational Age

BACKGROUND

Circadian rhythm development is mediated by pre- and postnatal factors. Premature birth interrupts development and exposes neonates to abnormal stimuli. Cycled lighting is an encouraging technique to stimulate formation of a 24-hour biological rhythm.

PURPOSE

Review the literature regarding benefits of cycled lighting versus other lighting conditions for premature infants and evaluate the optimal gestational age for initiation.

DATA SOURCES

Search of PubMed, CINHAL, and Google Scholar from 2012 to 2023.

STUDY SELECTION

Inclusion criteria covered effects of cycled lighting and focus on premature infants in the neonatal intensive care unit. Exclusion criteria were non-human studies and those that did not address the clinical question. Articles were limited to randomized controlled trials or systematic reviews. Sixteen articles were included in this review.

RESULTS

Research found inconsistent support for cycled lighting depending on the age at initiation when assessing weight gain, quality of movement, sleep and activity rhythms, ventilator days, length of stay, time to oral feeding, and irritability.

IMPLICATIONS FOR PRACTICE

Infants should be kept in continuous near darkness until 32 weeks gestational age to promote sleep. Benefits from cycled lighting start to be seen between 32 and 34 weeks of gestation with light levels between 10 and 600 lux. Delaying initiation until 36 weeks has not been shown to be beneficial.

IMPLICATIONS FOR RESEARCH

Future research should focus on stratifying infants based on gestational age at the time of initiation and consider the length of exposure time to cycled lighting while using larger sample sizes.

Children's satisfaction with nursing care during hospitalization: A cross-sectional study

PURPOSE

To assess hospitalized children's satisfaction with nursing care.

DESIGN AND METHODS

Cross-sectional study using the "Children Care Quality at Hospital" questionnaire. 61 children admitted to the Pediatrics Department of a hospital in the Northern Region of Portugal were enrolled.

RESULTS

The ranged age of the participants was 6 to 15 (10,61 ± 2,66 years), and most were male (52.46%; n = 32). The mean score in the three domains was 128 (77.11%), reflecting children's high satisfaction with the nursing care provided during hospitalization. The domain most valued was Nurse Characteristics, while the least valued was Nursing Environment.

CONCLUSION

Results provide essential input for the dimensions to be considered when planning nursing care for children, managing care, and the physical environment in the wards.

IMPLICATIONS FOR PRACTICE

These results highlight the need to hear children's voices. This must encourage nurses to reflect on how children evaluate nursing care and, by doing so, to increase the quality of nursing care provided in Pediatrics settings.

[Towards an ideal environment in neonatology]

The establishment of sensory systems occurs gradually along a transnatal continuum. During premature birth, hospitalization in neonatology, through its atypical sensory stimulations, can disrupt the development of the baby's still immature brain. To promote harmonious development in children, caregivers and parents must learn to take into account their sensory expectations in order to create the most suitable environment possible for their development.

Research Protocol for Sleep in Families With a Preterm Infant

BACKGROUND

Specificities regarding the quality and quantity of sleep of preterm infants and their parents following discharge of the preterm infant from the hospital are not well known. Given this lack of knowledge, the links between the sleep characteristics of these parents, family functioning, and their psychological well-being are also unclear.

OBJECTIVES

The purpose of this article is to summarize the research protocol of a cross-sectional, mixed-methods, convergent design study, which aims to evaluate the sleep patterns of preterm infants and both their parents and document the associations between sleep quality, parents' psychological well-being, and family functioning during the posthospitalization period.

METHODS

A convenience sample is used to recruit 30 families. For quantitative data collection, a questionnaire booklet consisting of validated questionnaires is used to measure sleep quality of each family member, parental psychological well-being, and family functioning completed by each parent. An actigraph and a sleep diary measure sleep quantity of each parent and the preterm infant. Afterward, semistructured interviews are carried out with each parent to explore their perceptions and needs concerning their infant's and their own sleep quality. For data analysis, qualitative and quantitative data are analyzed separately and then merged to allow for an integrative interpretation of the results.

RESULTS

The research project is ongoing; 25 of 30 families have completed the data collection. Data analysis is underway.

DISCUSSION

This research will provide a global portrait of the families' sleep 1 month after the preterm infant is discharged from the hospital, which is not well known to date. The results will help healthcare providers involved with preterm infants and their families after discharge from the hospital to increase their comprehension of the families' reality and adapt their interventions to meet these needs.

Early development of sleep and brain functional connectivity in term-born and preterm infants

The proper development of sleep and sleep-wake rhythms during early neonatal life is crucial to lifelong neurological well-being. Recent data suggests that infants who have poor quality sleep demonstrate a risk for impaired neurocognitive outcomes. Sleep ontogenesis is a complex process, whereby alternations between rudimentary brain states-active vs. wake and active sleep vs. quiet sleep-mature during the last trimester of pregnancy. If the infant is born preterm, much of this process occurs in the neonatal intensive care unit, where environmental conditions might interfere with sleep. Functional brain connectivity (FC), which reflects the brain's ability to process and integrate information, may become impaired, with ensuing risks of compromised neurodevelopment. However, the specific mechanisms linking sleep ontogenesis to the emergence of FC are poorly understood and have received little investigation, mainly due to the challenges of studying causal links between developmental phenomena and assessing FC in newborn infants. Recent advancements in infant neuromonitoring and neuroimaging strategies will allow for the design of interventions to improve infant sleep quality and quantity. This review discusses how sleep and FC develop in early life, the dynamic relationship between sleep, preterm birth, and FC, and the challenges associated with understanding these processes. IMPACT: Sleep in early life is essential for proper functional brain development, which is essential for the brain to integrate and process information. This process may be impaired in infants born preterm. The connection between preterm birth, early development of brain functional connectivity, and sleep is poorly understood. This review discusses how sleep and brain functional connectivity develop in early life, how these processes might become impaired, and the challenges associated with understanding these processes. Potential solutions to these challenges are presented to provide direction for future research.

Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants

Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the "Douleur Aigue du Nouveau-né" (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020)

BACKGROUND

The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.

Comparing light and noise levels before and after a NICU change of design

OBJECTIVE

To compare light and sound levels before and after a change of design and evaluate these levels considering recommended NICU standards.

STUDY DESIGN

A pre-test/post-test design. Light and sound levels were compared between the former open ward (OW) NICU of 34 beds and the current 40-bed unit composed of both pods and single-family rooms (SFR).

RESULT

Light levels were significantly higher in the pod/SFR unit for all levels of care, days of the week and time of the day. These findings could be attributed to the number and configuration of windows in the new pod/SFR unit allowing for more daylight entry compared to the OW. Sound levels were significantly lower in the current NICU (pod/SFR) compared to the former OW.

CONCLUSION

Following the change of design, the pod/SFR unit are less noisy than the OW, although light levels are higher indicating the necessity to measure light levels.

Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms

AIM

To determine whether children born extremely preterm are at increased risk for sleep disturbances and to explore relationships between extremely preterm birth, sleep and attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional symptoms.

METHOD

EPICure2 cohort study. Parents of 165 children born ≤26 weeks' gestation (53% male) and 121 children born at term (43% male) completed the Children's Sleep Habits Questionnaire, sleep disordered breathing subscale of the Pediatric Sleep Questionnaire, the emotional problems scale of the Strengths and Difficulties Questionnaire and the ADHD Rating Scale-5 at 11 years of age.

RESULTS

Extremely preterm children had greater habitual snoring (adjusted odds ratio 6.8; 95% confidence interval 2.3, 20.3), less frequently fell asleep within 20 minutes (Cohen's d 0.33), higher night wakings (d 0.44) and daytime sleepiness scores (d 0.40) than term-born children; there was no between-group difference in sleep duration scores. Among children without severe disability, night wakings scores partially mediated the relationship between preterm birth and inattention (additional 5% of variance explained), hyperactivity/impulsivity (13%) and emotional problems (9%). Snoring partially mediated the relationship between preterm birth, hyperactivity/impulsivity and inattention (additional 1-5% of variance).

CONCLUSION

Children born extremely preterm are at increased risk of disturbed sleep compared to term-born children. As night wakings partially mediated the relationship between preterm birth and ADHD symptoms and emotional problems, reducing sleep disturbance may improve sleep and reduce attention and emotional problems in this population.

Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement

The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.

Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation

Aim

To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

Design

Prospective observational study.

Methods

Twelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.

Results

Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

The lived experiences of critically ill infants hospitalised in neonatal intensive care: A scoping review

BACKGROUND

Neonatal intensive care saves lives, but the environment in which this occurs is complex and has been shown to negatively disrupt some aspects of an infant's early development. Identifying these negative effects has relied on measuring physiological and behavioural responses. Little research has sought to understand and learn from what an individual infant can communicate about their lived experience.

AIM

To examine what is known of the lived experiences of infants hospitalised in neonatal intensive care.

STUDY DESIGN

A scoping review using the revised Arksey and O'Malley framework was undertaken. Relevant studies, exploring an infant's experience of hospitalisation were identified through a comprehensive, systematic literature search.

RESULTS

4955 articles were retrieved, 88 full texts reviewed, and 23 studies included. We identified no studies that assessed the experience from the infant's perspective. The infant experience was explored using quantitative methodology, characterising, and describing the experience in measurable physiological, behavioural, and neurodevelopmental terms or through the lens of medical outcomes. The environment is described as too loud and too bright and infants are exposed to high levels of medical handling, impacting on physiology, behaviour, sleep, feeding, and both short- and longer-term outcomes.

CONCLUSION

The studies captured in this review focused on quantitative, measurable outcomes as a proxy for the experience as it might be felt, interpreted, and processed by an infant. Medical focus has been crucial to advance the field of neonatology, but the review highlights an important gap; the need to explore and better understand the infant's experience through their eyes.

Sleep and prematurity: sleep outcomes in preterm children and influencing factors

BACKGROUND

Sleep undergoes changes from birth to adulthood, while sleep disorders are associated with various cognitive deficiencies in childhood. In parallel, prematurity is known to predispose to poor neurodevelopmental outcomes. Our aim is to provide literature data about factors influencing sleep in the premature infants and sleep outcomes in this population.

METHODS

A systematic review was conducted using a variety of health-related databases. Original research papers were considered and no year-of-publication restriction was placed.

RESULTS

In total, 22 articles fulfilled our selection criteria. Available studies present remarkable heterogeneity in terms of methodological design. Compared to full term, premature infants exhibit significant differences in sleep structure, which mainly include differences in electroencephalographic spectral values, in total sleep time and in arousal threshold. Furthermore, prematurity seems to be a risk factor of sleep breathing disorders in childhood and adolescence. Data about the effect of methylxanthines and the environment of neonatal intensive care unit is controversial. With regard to the impact of prematurity-related sleep disorders on future neurodevelopment, available research papers are generally few.

CONCLUSIONS

The alterations in sleep patterns are an outcome of prematurity (immaturity of nervous system) as well as of postnatal factors and comorbidities. Sleep problems in this population of infants seems to be a missing piece of the puzzle of impaired neurodevelopment. Future studies should focus on interventions to improve sleep hygiene and limit neurodevelopmental problems.

The case for a chronobiological approach to neonatal care

Time of day is a critical factor for most biological functions, but concepts from the field of chronobiology have yet to be fully translated to clinical practice. Circadian rhythms, generated internally and synchronised to the external environment, promote function and support survival in almost every living species. Fetal circadian rhythms can be observed in utero from 30weeks gestation, coupled to the maternal rhythm, but synchronise to the external environment only after birth. Important cues for synchronisation include the light/dark cycle, the timing of feeding, and exposure to melatonin in breast milk. Disruption to these cues may occur during admission to the neonatal intensive care unit. This can impair the development of circadian rhythms, and influence survival and function in the neonatal period, with a potential to impact health and well-being throughout adult life. Here we outline the rationale and evidence to support a chronobiological approach to neonatal care.