SLEEP IN THE NEONATAL INTENSIVE CARE UNIT
Bertelle V, Sevestre A, Laou-Hap K, Nagahapitiye MC, Sizun J: J Perinat Neonat Nurs. 2007;21(2):140-148.
This review included objectives of learning how to identify sleep states, understanding the role of sleep, and exploring how neonatal developmental care (DC) may improve sleep quality in the neonatal intensive care unit (NICU).
The authors describe behavioral scales and their correlation with polysomnographic identification of sleep/wake states. They explain the vital biological role of sleep, noting that its exact functions in neonates remain speculative.
They conducted a study using an experimental, prospective, crossover design to determine the impact of neonatal DC on aspects of sleep in preterm neonates. They used the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), which was developed by Heidelise Als as a program for infants in NICUs. There are several recommendations in NIDCAP relating to promotion of sleep.
The study participants were 33 preterm infants without ventilator support. Each infant was his or her own control for 2 consecutive periods of 3 hours, with and without DC. Control conditions were those which existed before the use of NIDCAP. Recordings of sleep states were made with a computerized somnograph, electroencephalography, and electrooculography. Heart and respiratory rates were also recorded.
Statistical estimations between groups were made with the Wilcoxon test. The researchers found that total sleep time was higher in DC conditions than in controls (2.9 vs 4.6 hours, P = .002), with increases in quiet sleep and active sleep. The longest period of uninterrupted quiet sleep was higher in DC conditions than in controls (2.1 vs 10.5 minutes, P = .0005).
The researchers conclude that NIDCAP seems to have a positive impact on sleep in the NICU. However, they note that further research is needed.
RANDOMIZED CONTROLLED ACCESS TRIAL OF VASCULAR ACCESS IN NEWBORNS IN THE NEONATAL INTENSIVE CARE UNIT
Barria RM, Lorca P, Munoz S. JOGNN. 2007;36:450-456.
A randomized controlled clinical trial was conducted with 74 high-risk newborns in a neonatal intensive care unit (NICU) in the Regional Hospital of Valdivia, Chile, to compare the effectiveness of 2 types of vascular access. The type of access for newborns was either a peripherally inserted central catheter (PICC) or a peripheral intravenous catheter (PIV). Outcomes that were measured were length of stay in the NICU and incidence of sepsis and phlebitis.
There were 37 newborns in each group. There were no statistically significant differences between the 2 groups with regard to birth weight, gestational age, gender proportion, very low birth weight, use of mechanical ventilation, total parenteral nutrition, antibiotic therapy, or umbilical artery catheterization.
There was no statistically significant difference in the length of NICU stay between PICC and PIV groups (20 days vs 17 days, P = .158) nor in the incidence of sepsis (2.8% vs 5.1%, P = .530). However, there was a significant difference in the incidence of phlebitis between PICC and PIV groups (10.8% vs 40.5%, P = .007).
The authors note that the low frequency of sepsis showed a lack of power to detect differences between groups. They maintain that longer placement of PICC lines reduces pain associated with venipuncture.