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Feasibility Case Series of Environment and Sleep in Infants With Congenital Heart Disease
Laura Beth Kalvas1, Tondi M Harrison
1Laura Beth Kalvas, MS, RN, PCCN, is Graduate Fellow, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus.
Insights
Infants with complex congenital heart disease (CCHD) experience noisy hospital environments and fragmented sleep, potentially impacting development. This study explored data collection feasibility in pediatric cardiac care units.
Area of Science:
- Neonatal care
- Pediatric cardiology
- Environmental monitoring
Background:
- Developmental delay is a significant concern for infants with complex congenital heart disease (CCHD).
- Neonatal intensive care environments, including excessive light and sound, are linked to poor developmental outcomes.
- The specific environmental exposures for infants in cardiac care are not well understood.
Purpose of the Study:
- To assess the feasibility of continuous environmental data collection (light, sound, sleep) in pediatric cardiac care units.
- To describe the environmental exposures and sleep patterns of hospitalized infants with CCHD.
Main Methods:
- A case series of three infants with CCHD undergoing cardiac surgery.
- Continuous monitoring of light, sound, and sleep patterns over 24-hour periods on hospital days.
- Feasibility assessed via family/staff acceptability, equipment usability, and protocol adherence.
Main Results:
- Continuous data collection was generally acceptable, but usability issues and variable adherence led to missing data.
- Infants experienced frequent excessive sound exposure, but light levels were generally within recommended limits.
- Infant sleep was highly fragmented with frequent arousals and short sleep durations.
Conclusions:
- Preliminary data collection identified challenges in monitoring this vulnerable population.
- The cardiac care environment is characterized by excessive noise and disrupted sleep, posing potential risks to infant development.
- Lessons learned will inform future large-scale studies on environmental impacts on CCHD infants.
Background:
Developmental delay is a significant concern for infants born with complex congenital heart disease (CCHD). Environmental exposures (e.g., excessive light and sound exposure, sleep disruption) in neonatal intensive care are associated with poor developmental outcomes. However, the environmental experience of newborn infants in cardiac care is unknown.
Objectives:
The aim of the study was to examine the feasibility of continuous environmental data collection (i.e., light and sound exposure, sleep pattern) in pediatric cardiac care units and describe the environmental experience of three hospitalized infants with CCHD.
Methods:
A case series of three infants undergoing cardiac surgery for CCHD within the first month of life was performed. Measures of light, sound, and sleep were collected in 24-hour periods on three to four separate hospital days. For each day, light and sound meters were attached to the hospital bed, and an actigraphy band was placed on the infant's lower leg to measure sleep/wake states. Feasibility of continuous environmental data collection was assessed through acceptability of data collection for families and clinical staff, usability of data collection equipment for research staff, and study protocol adherence. Descriptive statistics were used to calculate the count and duration of episodes of excessive light and sound exposure, hourly levels of light and sound exposure, total sleep time, duration of individual sleep episodes, and number of arousals from sleep.
Results:
Although continuous environmental data collection was generally acceptable to families and clinical staff, multiple usability issues were identified by research staff, and study protocol adherence was variable. Missing data were a major limitation. User error during equipment setup was a main contributor to missing data. Infants experienced frequent episodes of sound exposure above recommended maximum levels, whereas light exposure generally remained below recommended maximum levels. Infant sleep patterns were highly fragmented, with frequent arousals and short duration of individual sleep episodes.
Discussion:
Lessons learned during preliminary data collection with the infants in this case series will inform methods and prevent missing data in future, large-scale studies of this vulnerable, hard-to-recruit population. Data reflect a cardiac care environment characterized by excessive sound exposure and highly disrupted sleep. These environmental stressors may affect developmental outcomes in infants with CCHD.
