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A systematic review of chronobiology for neonatal care units: What we know and what we should consider
Philip Lewis1, Ursula Wild1, J Jane Pillow2
1Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany.
Insights
Chronobiological factors like light-dark cycles may impact hospitalized infant health, but evidence is limited. More research is needed to understand these effects and optimize neonatal care.
Area of Science:
- Neonatal Health
- Chronobiology
- Evidence-Based Medicine
Background:
- Previous reviews suggest cycled light may benefit hospitalized neonates.
- Chronobiological factors, including light-dark cycles, feeding, noise, and massage, are explored for their impact on neonatal health.
- Limited empirical evidence currently supports widespread chronobiological interventions in neonatal care.
Approach:
- Systematic review of 56 studies on chronobiological factors in neonatal hospital units.
- Analysis of research on light-dark cycles, feeding, noise, massage therapy, rooming-in, incubators vs. cribs, neonatal units vs. homes, and time-of-day of birth.
- Assessment of study generalizability, focusing on neonates in stable condition without congenital anomalies.
Key Points:
- Empirical evidence for chronobiological benefits, including light, is weaker than anticipated.
- Mechanisms linking chronobiology to clinical benefits (e.g., sleep, weight gain, hospital stay duration) require further elucidation.
- Most studies focus on sleep and circadian outcomes, with less data on clinically relevant measures like weight gain.
Conclusions:
- Further research is essential to explore circadian entraining signals (e.g., meal timing) and their impact on hospitalized neonates.
- Longer-term outcomes, such as neurodevelopment and infection rates, and risks associated with time-of-day of birth effects remain underexplored.
- Significant potential exists for research into optimizing chronobiological factors for improved neonatal health in hospital settings.
Abstract:
A Cochrane 2016 review indicated cycled light might benefit neonatal health in hospital. We systematically reviewed chronobiological factors for neonatal health in hospital units, identifying 56 relevant studies on light-dark cycles, feeding, noise, massage therapy, rooming-in, incubators vs. cribs, neonatal units vs. homes, and time-of-day of birth. Empirical evidence for benefits from chronobiology is weaker than expected, including light. Mechanisms of clinical benefits are unclear (e.g., changes to sleep/activity vs. other circadian-regulated processes). Regarding light, studies concerning sleep and circadian-related outcomes predominate; yet, neonatologists may be more interested in weight gain and time spent in hospital. Generalisability of findings is limited as most studies targeted neonates in stable condition and without congenital anomalies. Further research is needed, in particular concerning potential circadian entraining signals such as timing of meals or medications. Longer-term outcomes (regarding e.g., neurodevelopment and infection), and who may be at risk from time-of-day of birth effects and why remain to be explored. Overall, there is promise and ample scope for research into how chronobiological factors affect health in hospitalised neonates.
