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How to improve sleep in a neonatal intensive care unit: A systematic review
Agnes van den Hoogen1, Charlotte J Teunis2, Renée A Shellhaas3
1University of Utrecht, Medical and Clinical Health Science, The Netherlands; Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands.
Insights
Improving sleep for infants in the neonatal intensive care unit (NICU) is crucial for brain development. While many interventions exist, current evidence is insufficient to recommend new strategies for neonatal sleep promotion.
Area of Science:
- Neonatal neuroscience
- Developmental pediatrics
- Sleep medicine
Background:
- Sleep is vital for neural pathway development in neonates.
- Evidence-based strategies to improve neonatal intensive care unit (NICU) sleep exist but are underutilized.
- Implementing improved sleep protocols is essential for infant well-being.
Purpose of the Study:
- To systematically review interventions promoting sleep in the NICU.
- To identify and synthesize evidence on effective sleep-promoting strategies for neonates.
- To develop guidelines for improving neonatal sleep in intensive care settings.
Main Methods:
- Systematic literature search adhering to PRISMA guidelines.
- Searches conducted in PubMed, CINAHL, and Cochrane Library (2016-2017).
- Inclusion of 14 studies (10 RCTs, 3 quasi-experimental) with quality assessment.
Main Results:
- Kangaroo care and certain touch therapies (Yakson, GHT) showed positive effects on infant sleep behavior and states.
- Mixed results were observed for sleep surfaces and music interventions.
- Cycled light showed some positive effects, while NIDCAP and massage therapy had no significant impact on sleep.
Conclusions:
- Significant heterogeneity exists in studies assessing neonatal sleep interventions.
- Insufficient evidence currently supports recommending new interventions for NICU sleep promotion.
- Guidelines based on moderate evidence, expert opinion, and parental values are suggested to improve NICU sleep and guide future research.
Abstract:
There is increasing evidence that sleep plays a major role in the development of neural pathways in the neonatal brain. Several studies have suggested evidence-based approaches to improve sleep for infants admitted to the neonatal intensive care unit (NICU); however, in many neonatal centers very few of these strategies seem to be implemented in routine care.
Objective:
To systematically review the literature to determine interventions promoting neonatal sleep on the NICU, in order to develop key guidelines to improve neonatal sleep.
Methods:
A systematic search was conducted according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting systematic reviews. The search was performed in Pubmed, CINAHL and the Cochrane Library on 19 September 2016 and again on 28 January 2017.
Results:
In total, fourteen studies were included (10 RCT's and three quasi-experimental study designs): four studies were of high quality, eight of moderate quality and two of low quality. Two studies investigating kangaroo care reported significant effect on infant sleep behavior, two studies comparing Yakson and Gentle Human Touch (GHT) found significant effect on behavioral states and one study reported an increase in sleep behavior using different sleep surfaces. One study showed a significant effect on sleep patterns using music as an intervention and one study showed no significant effect using music. Two studies showed no significant effect on infant sleep using cycled light and different types of LED-light and one study showed significant effect of cycled lightning. There were no effects of Neonatal Individualized Developmental Care Program (NIDCAP) or massage therapy.
Conclusion:
Although many different interventions have been reported to promote sleep in infants who require intensive care, there is great heterogeneity across studies: the methods of sleep assessment, the targeted sleep behaviors, and the study populations vary significantly across published reports. Based on the results there seems to be insufficient evidence to recommend any new intervention to promote neonatal sleep on the NICU. However because of the importance of sleep for the development of the neonatal brain we do suggest some key guidelines based on moderate evidence, expert opinion and parental values to improve sleep on the NICU and to direct future neonatal sleep studies.
