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Updated: Jul 19, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Evaluation of Sleep Practices and Knowledge in Neonatal Healthcare
Eline R de Groot1, Mary-Anne Ryan, Chanel Sam
1Department of Neonatology, Wilhelmina Children's Hospital (Mss de Groot and Sam and Drs Alderliesten, Dudink, and van den Hoogen), and Brain Centre Rudolf Magnus (Drs Alderliesten and Dudink), University Medical Center Utrecht, Utrecht, the Netherlands; INFANT Centre, University College Cork, Cork, Ireland (Ms Ryan); Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland (Ms Ryan); and UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine (Dr Verschuren), Utrecht University (Dr van den Hoogen), Utrecht, the Netherlands.
Insights
Healthcare professionals recognize the importance of sleep for preterm infants but lack knowledge of sleep physiology. While care procedures are adapted to sleep, assessments are not scientifically based, and sleep is infrequently discussed in practice.
Area of Science:
- Neonatal care
- Developmental neuroscience
- Sleep medicine
Background:
- Developmental care aims to optimize brain maturation in preterm infants.
- Protecting sleep is crucial for preterm infants in the neonatal intensive care unit (NICU).
- Current awareness and implementation of neonatal sleep practices in the NICU are not well understood.
Purpose of the Study:
- To assess healthcare professionals' knowledge of neonatal sleep.
- To understand how this knowledge is applied in daily NICU care.
- To identify gaps in sleep-related practices and education.
Main Methods:
- A survey was administered to Dutch healthcare professionals in the NICU.
- Data collected included respondent demographics, sleep practices, and objective knowledge of sleep physiology.
- Statistical analyses included Spearman's rho and Cramer's V tests, alongside frequency and qualitative analyses.
Main Results:
- 427 professionals from 34 hospitals participated, recognizing sleep's importance for neonates.
- Respondents scored low on knowledge of sleep physiology, with sleep assessments lacking scientific basis.
- While 91.8% adapted care timing to sleep, sleep was rarely discussed during rounds (7.5%-14.3%) or between colleagues (27.4%).
Conclusions:
- There is a need to enhance neonatal healthcare professionals' education on sleep physiology.
- Increased consideration of sleep during clinical rounds and handovers is recommended.
- Improving sleep assessment accuracy and interprofessional communication is vital for optimizing developmental care.
Background:
Developmental care is designed to optimize early brain maturation by integrating procedures that support a healing environment. Protecting preterm sleep is important in developmental care. However, it is unclear to what extent healthcare professionals are aware of the importance of sleep and how sleep is currently implemented in the day-to-day care in the neonatal intensive care unit (NICU).
Purpose:
Identifying the current state of knowledge among healthcare professionals regarding neonatal sleep and how this is transferred to practice.
Methods:
A survey was distributed among Dutch healthcare professionals. Three categories of data were sought, including (1) demographics of respondents; (2) questions relating to sleep practices; and (3) objective knowledge questions relating to sleep physiology and importance of sleep. Data were analyzed using Spearman's rho test and Cramer's V test. Furthermore, frequency tables and qualitative analyses were employed.
Results:
The survey was completed by 427 participants from 34 hospitals in 25 Dutch cities. While healthcare professionals reported sleep to be especially important for neonates admitted in the NICU, low scores were achieved in the area of knowledge of sleep physiology. Most healthcare professionals (91.8%) adapted the timing of elective care procedures to sleep. However, sleep assessments were not based on scientific knowledge. Therefore, the difference between active sleep and wakefulness may often be wrongly assessed. Finally, sleep is rarely discussed between colleagues (27.4% regularly/always) and during rounds (7.5%-14.3% often/always).
Implications:
Knowledge about sleep physiology should be increased through education among neonatal healthcare professionals. Furthermore, sleep should be considered more often during rounds and handovers.
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