Avaliação do estado comportamental durante o sono em recém-nascidos / Behavioral assessment of sleep state in newborns

INTRODUÇÃO: A identificação dos estados comportamentais é um fator determinante na avaliação clínica e neurofisiológica de neonatos e apresenta-se como indicador importante do desenvolvimento normal e anormal do sistema nervoso central. As variáveis fisiológicas importantes na avaliação comportamental são: freqüência cardíaca, freqüência respiratória, presença de movimentos oculares rápidos, eletromiograma (EMG), eletroencefalograma (EEG). As variáveis comportamentais são abertura e fechamento dos olhos, movimentos corporais e choro. MÉTODOS: Neste artigo, foi feita uma revisão da literatura no período de 1970-2008 utilizando os unitermos: estado comportamental e recém-nascidos, sono e recém-nascidos e, EEG e comportamento. Utilizou-se os banco de dados Medline, Scielo e Web of Science. Esta revisão foi desenvolvida no período de agosto a novembro de 2008. CONCLUSÕES: A sistematização dos achados do comportamento em recém-nascidos associado à organização bioelétrica e grafoelementos permite identificar precocemente o comprometimento encefálico e prognóstico de recém-nascidos de risco e de muito baixo peso. Na literatura existem controvérsias em relação à padronização e sistematização dos estados comportamentais de crianças prematuras, diferente do que ocorre em neonatos a termo onde estes aspectos já estão definidos.

INTRODUCTION: The identification of behavioral states is a determining factor in the clinical and neurophysiological evaluation of neonates and presents itself as an important indicator of normal and abnormal development of the central nervous system. The physiological variables that are important in behavioral assessment are: heart rate, respiratory frequency, presence of rapid eye movements, electromyogram, electroencephalogram and behavioral variables (opening and closing of the eyes, body movements, crying). METHODS: In this article, we performed a comprehensive review of the literature in the period of 1970- 2008 where a search was conducted involving the terms, behavioral states and newborns/sleep and newborns/EEG and behavior. We used the database Medline, Scielo and Web of Science. This review was done in the period between August and November 2008. CONCLUSIONS: The systematization of the findings of behavior in newborns associated with the bioelectric and graphic element organization permit the early identification of brain impairment and prognosis of newborns at risk with low birth weight. In literature there are still controversies regarding standardization and systematization of behavioral states of premature children, in term children this has been already defined.

Determination of Behavior and the Stimuli-dependent Transition of the Probability of Behavioral Expression: A Study on the Fluctuation of Behavioral State as Represented by the Level of Body Movement Suppression

The behavior of most animals is extremely complex. Despite accumulating knowledge about the mechanisms of neurons and nervous systems, which regulate these complex behaviors, we have little understanding about how these mechanisms function. In the present study, we analyzed the exploratory behavior of mice repeatedly exposed to a novel context and tracked the changes in the fluctuation patterns of the accumulated level of body movement suppression (BMS). As a result, we found that the fluctuation in BMS can be divided into two phases, which show a pattern of progressive transition from the initial state to the context-dependent and stable equilibrium state. In the former, transition phase, the level of BMS was easily affected by the number of exposures and mental status of mice. However, in the latter, equilibrium phase, the level of BMS was only dependent on the environmental stimuli involved in the context. On the basis of the results, we suggests here a model that explains the determination of complex behavior observed in higher animals by means of the probability of behavioral expression.

Effect of Cycled Lighting and Auditory Stimulation on Body Weight, Physiological Variables and Behavioral States in Low Birth Weight Infants

PURPOSE: This study was aimed at finding the effects of cycled lighting and auditory stimulation on body weight, physiological variables and the behavioral state of low birth weight infants (LBWI) in the neonatal intensive care unit (NICU). METHODS: The subjects were 30 LBWI at 2 NICUs. They were assigned to experimental I, experimental II and control group which consisted of 10 subjects in each of their regular sequence. Cycled lighting was applied to the experimental group I for 10 days, cycled light and auditory stimualtion were applied to the experimental group II. RESULTS: It was certified that the application of cycled lighting and auditory stimulation resulted in increased body weight, decreased heart rate, and stabilization of the behavioral states of the LBWI. However, there was no effect on increase of O2 saturation and decrease of respiration rate. CONCLUSION: The application of cycled lighting and auditory stimulation might be interventions which would in turn have positive effects on the growth and development of LBWI.

The Effect of Music Therapy on the Heart Rate and Behavioral State of Premature Infants / 아동간호학회지

PURPOSE: This study was conducted to investigate the effect of music therapy as auditory stimulus on the heart rate and behavioral state of premature infants. METHOD: The study design was a non-equivalent control group pretest-posttest design. Forty premature infants who were admitted at NICU were selected and assigned to two groups, experimental and control. Data were collected from April 20 to July 31, 2003 and analysed using Wilcoxon rank sum test and ANCOVA. Infants in experimental group were given music therapy for 20 minutes daily in 7 days at the average level of 56dB. RESULTS: The first hypothesis that 'Infants in the experimental group will be lower in heart rate than those in the control group' was rejected(F= .05, p= .816). The 2nd hypothesis that 'Infants in the experimental group will be lower in behavioral state score than those in the control group, was supported(F=7.40, p= .010). CONCLUSION: The music therapy in this study was an effective nursing intervention in decreasing the heart rate and behavioral state score of premature infants.

Effect of Non-Nutritive Sucking on the Oxygen Saturation Level and Behavioral State of Preterm Infants during Tube Feeding

PURPOSE: The main purpose of this study was to evaluate effects of non-nutritive sucking (NNS) on the oxygen saturation level and behavioral state of preterm infants during tube feeding. METHODS: This study was performed prospectively in the NICU, Chonbuk National University Hopspital from November, 2004 through April, 2005. Preterm infants of gestational age 28 to 37 weeks, who had neither major congenital defects interfering feeding nor respiratory difficulty needing ventilatory support, were included. A total of 64 subjects were divided randomly into the control group (n=32), and the non-nutritive sucking (NNS) group (n=32). The patients in each group were tested for changes in oxygen saturation and behavioral state at 3 different times; 2 minutes before, during, and 2 minutes after feeding. RESULTS: The oxygen saturation of the NNS group increased during feeding and gradually decreased after feeding while the control group decreased during feeding and increased slightly after feeding (P<0.001). During feeding, the "quiet awake" state was observed more frequently in the NNS group and the "crying" state was observed more frequently in the control group. During the post-feeding assessment, the "sleep" state was more frequent in the NNS group and the "crying" state was more frequent in the control group. CONCLUSION: The infants in the NNS group showed significantly higher oxygen saturation level and they were less fussy during tube feeding and slept better after feeding.

Effects of Non-nutritive Sucking on the Physiological and Behavioral States of Pre-term Infants during Tube Feeding / 간호학회지

PURPOSE: This study was to investigate the effects of non-nutritive sucking on physiological and behavioral state of pre-term infants during tube feeding. METHOD: This nonequivalent, non-synchronized experimental study included 50 pre-term infants. An attempt was made to match gestational age and birth weight of infants in each group. Infants in the experimental group were given a pacifier 2 minutes before, during, and for 2 minutes after tube feeding. Infants in the control group did not get a pacifier. Both groups were tested at three stages for changes in the physiologic state and behavioral state-2 minutes before, during, and 2 minutes after feeding. Date was analyzed with SPSS WIN 10.0 using an chi-square-test, t-test, and repeated measures ANOVA. RESULT: Heart rates and oxygen saturation levels of the two groups were significantly different(P=.001, P=.000). The behavioral states of the two groups were significantly different during and post feeding(P=.000, P=.000). CONCLUSION: This result suggests non-nutritive sucking by using a pacifier is an effective intervention for pre-term infants during tube feeding.

Effects of Cycled Lighting on Body Weight, Physiological Variables and Behavioral States in Low Birth Weight Infants / 간호학회지

PURPOSE: This study was aimed at finding the effects of cycled lighting on body weight, physiological variables and the behavioral state of LBWI (low birth weight infants) in the NICU. METHOD: The subjects were 20 LBWI at 2 NICUs. They were assigned to an experimental or control group which consisted of 10 subjects in each. Cycled light was applied to the experimental group for 10 days. RESULT: It was certified that the application of cycled lighting resulted in increased body weight and O2 saturation, and decreased heart rate of the LBWI. However, there was no effect in decrease of respiration and stabilization of the behavioral state. CONCLUSION: The application of cycled lighting might be a nursing intervention which would in turn have positive effects on the growth of LBWI.

The Effects of Meridian Massage on the Behavioral State and Weight in Infants / 아동간호학회지

PURPOSE: This study was implemented to develop new nursing intervention, Meridian Massage, and to investigate its effect on weight, behavioral state in infants.METHOD: This study has been conducted on the non equivalent control group pretest-posttest design in quasi experimental basis and newly born infants from Postpartum Management Center were selected in two groups of 35 infants. Data has been collected from February 1st to October 30th of 2002. The experimental group(20) took Meridian massage for 15 minutes daily twice during 6 days and control group took Field massage as same time. Weight has been determined 10:00 hours everyday morning and behavior status has been determined before and after 5 minutes beth by Anderson et al.(1990) tools. Data was analyzed by SPSS 11.0 Program using t-test, chi2-test and repeated measures ANOVA. RESULT: The results were as follow. In the aspect of behavioral status, Meridian massage group(55.8%) showed increase "positive" state than Field massage group(42.6%). And there was statistical significance(p=.002). Meridian massage group showed higher in the average weight than Field massage group(F=6.753, p=.014), and there was significant term between the two groups(F=10.129, p=.000). But there was no interaction group and term. CONCLUSION: The Meridian Massage in this study showed more positive aspect in weight gain and positive behavior status than Field Massage. This study has informed that meridian massage is an effective nursing intervention in improving Infant development.

Effects of Progressive Muscle Relaxation on Behavioral States and Emotional Reactions of Adolescent Athletes / 아동간호학회지

This study was designed to investigate the effects of the progressive muscle relaxation on behavioral states and emotional reactions of adolescent athletes. The participants were 167 adolescent male soccer players aged between 12 and 18 who were junior or high school students in Seoul. Ninety-three of them were assigned to the experimental group, while seventy-four to the control group. The experimental group was treated by 10 sessions (20 min./session) of Jacobson's progressive muscle relaxation for two weeks, while the control group was not treated. The self and observer reported behavioral states, general stress by visual analogue scale, physical symptoms of stress, athletic stress, state anxiety, depression, self-esteem were measured before and after two weeks of the progressive muscle relaxation. The results were as follows ; 1. The self and observer reported behavioral states were significantly decreased in the experimental group compared with the control group. 2. The general stress and the gastrointestinal symptoms of stress were significantly decreased in the experimental group compared with the control group. No significant difference on athletic stress was found between the two groups. The depression and the state anxiety were significantly decreased in the experimental group compared with the control group. The self-esteem was significantly increased in the experimental group compared with the control group. 3. The influential factors on behavioral state of adolescent male athlete were depression and state anxiety. The accelerating factor on behavioral state change after the progressive muscle relaxation was state anxiety. These results are suggested that the progressive muscle relaxation could be effective in stabilizing behavioral state, decreasing general stress, gastrointestinal symptoms of stress, depression, state anxiety, in increasing self-esteem of adolescent male athletes. And the behavioral state change after the progressive muscle relaxation was influenced by state anxiety.

Effects of Nonnutritive Sucking on Behavioral State in Preterm Infants / 아동간호학회지

The purpose of study was to examine the effect of nonnutritive sucking(NNS) on behavioral state in preterm infants. Fourteen infants(gestational age 28-35 weeks, M=31.86 ; birth weights 1095-2275g, M=1694g) admitted to NICU, serving as their controls were randomly administered 5 min of nonnutritive sucking and a control condition. Behavioral state was measured using the Anderson Behavioral State Scale(ABSS). Heart rates were obtained for each infant before and during NNS and bottle feeding. Data collection was done by 3 experienced nurses in NICU 2 times a day for consecutive 4 days for each subject. Interrater reliability were .80-.90. The findings were as follows : 1. Preterm infants averaged active restless states 58.93% in the preintervention phase and 27.32% in the NNS phase. Inactive awake states were 3.57% in the preintervention phase and 34.64% in the NNS phase. 2. There were significantly more positive changes to inactive awake states for the NNS intervention, Z=-2.35, p=.01. 3. There was no statistically significant difference in heart rate change between NNS intervention and control condition, z=-1.15, p=.24. 4. The rates of feeding success determined by finishing prescribed amount of milk by bottle feeding within 15 minutes were 83.94% in NNS intervention and 89.29% in control condition. The findings from this study confirmed that NNS is effective for behavioral state modulation and inducing optimal state for feeding in preterm infant. The NNS intervention in nursing practice may help the transition of preterm infants for nipple feeding.