Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study.

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the "quiet" times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors (p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants.

PURPOSE: To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. METHODS: This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). FINDINGS: Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. CONCLUSIONS: Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. IMPLICATION FOR NURSING PRACTICE: Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of "Quiet Time".

BACKGROUND: Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day. PURPOSE: To determine the impact of quiet time on reducing sound levels and increasing total sleep time. METHODS: This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours. RESULTS: The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours. IMPLICATIONS FOR PRACTICE: Quiet time is a nursing intervention that should be implemented in all neonatal units. IMPLICATIONS FOR RESEARCH: Future research should use a greater sample size and other factors that influence sleep should be further investigated.

Effects of Handling and Environment on Preterm Newborns Sleeping in Incubators.

OBJECTIVE: To describe the total sleep time, stages of sleep, and wakefulness of preterm newborns and correlate them to levels of sound pressure, light, temperature, relative air humidity, and handling inside incubators. DESIGN: Observational, correlational study. SETTING: A neonatal intermediate care unit. PARTICIPANTS: Twelve preterm newborns, who were 32.2 ± 4.2 weeks gestational age and weighed 1,606 ± 317 g. METHODS: Sleep records were assessed by polysomnograph. Environmental variables were measured with a noise dosimeter, light meter, and thermohygrometer. To record time and frequency of handling, a video camera was used. All recordings were made for an uninterrupted 24-hour period. RESULTS: Mean total sleep time in 24 hours was 899 ± 71.8 minutes (daytime = 446 ± 45.3 and nighttime = 448 ± 60.2). Mean wakefulness was 552 ± 94.0 minutes. The predominant stage was quiet sleep. A significant correlation was identified only between the levels of light and wakefulness (r = 0.65 and p = .041). CONCLUSION: The environmental conditions and care provided to hospitalized preterm newborns did not influence sleep except for high light levels, which increased wakefulness. Nurses in clinical practice should implement strategies to promote and protect sleep by decreasing newborns' exposure to excessive light.

Effect of sleeping position on arousals from sleep in preterm infants.

PURPOSE: To evaluate the frequency of preterm infant positions during sleep, and to investigate the association among positions, arousals, sleep patterns, and time of day. DESIGN AND METHODS: This observational study was conducted in a neonatal unit with 10 preterm infants. Polysomnographic and video recordings during 24 hr identified sleep positions, arousals, sleep patterns, and time of day. RESULTS: Preterm infants were placed most frequently in the supine position (58.4%), followed by right side (24.9%), left side (15.5%), and prone (1.2%). The longest amount of time spent sleeping, and the most frequent number of arousals, occurred in the supine position, followed by prone, left-side, and right-side positions. After controlling for length of time spent in each position, the number of arousals per hour was the greatest in the supine position (13.562 ± 0.732) and least in the prone position (11.56 ± 4.754; p < .001). There were no significant differences in arousals according to position and sleep pattern (indeterminate, quiet, active sleep) or position and time of day (morning, afternoon, twilight, night). PRACTICE IMPLICATIONS: Nurses should evaluate the frequency of preterm infant arousals in each position, and use more often those positions that lead to a lower frequency of arousals and better sleep quality.

Polysomnography assessment of sleep and wakefulness in premature newborns.

OBJECTIVE: to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD: a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS: the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION: the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Influência da posição da criança no leito sobre o sono: revisão integrativa / Influence of sleeping position of the infant on sleep: an integrative review / Influencia de la posición del nino en la cama sobre el sueno: revisión integradora

Este estudo teve como objetivo verificar a influência da posição de dormir no sono da criança. Uma revisão integrativa foi conduzida nas bases de dados Pubmed, LILACS, SciELO e Cochrane, com os descritores "sleep", "infant" e as expressões "position" e "positioning", nos idiomas espanhol, inglês e português, publicadas entre 2000 e 2013. Seis artigos que atenderam aos critérios de inclusão e exclusão foram identificados. Os estudos foram categorizados em despertares e estágios de sono. Os resultados indicaram que a criança na posição prona apresenta menor quantidade de despertares, possibilitando sono ativo mais profundo e maior quantidade de sono quieto. A posição supina está relacionada à maior quantidade de sono ativo e mais despertares e não expõe a criança ao risco da síndrome da morte súbita infantil. Concluiu-se que a posição supina possibilita mais despertares que a prona, entretanto, promove mais segurança da criança durante o sono.

This study aimed to verify the influence of infant sleeping position on sleep. An integrative literature review was conducted in Pubmed, LILACS, SciELO and Cochrane, with the descriptors, "sleep', "infant' and the terms "position' and "positioning", in Spanish, English and Portuguese, published between 2000 and 2013. Six articles met the criteria for inclusion and exclusion. These studies were categorized into arousal from sleep and sleep stages. The results indicated that in the prone position, the infant had fewer arousal events, enabling deeper active sleep and greater amount of quiet sleep. The supine position is related to a greater amount of active sleep and more arousals, and does not expose the infant to the risk of Sudden Infant Death Syndrome. The supine position results in more arousals than the prone position, however, it promotes greater safety to the infant during sleep.

El objetivo de este estudio fue verificar la influencia de la posición de dormir sobre el sueno del nino. Se realizó una revisión integradora en las bibliotecas PubMed, LILACS, SciELO y Cochrane con los descriptores sleep, infant y las expresiones position y positioning, en espanol, inglés y português, publicados entre 2000y 2013. Fueron identificados seis artículos que atendían los criterios de inclusión. Los estudiosfueron clasficados en despertares y etapas del sueno. Los resultados indicaron que el nino en la posición prona presenta menor cantidad de despertares, lo cual permite un sueno activo más profundo y una mayor cantidad de sueno tranquilo. La posición supina se relaciona con una mayor cantidad de sueno activo y de despertares y no expone al nino al riesgo del síndrome de muerte súbita del lactante. Se llegó a la conclusión que en la posición supina hay más despertares que en la prona pero que, sin embargo, durante el sueno, esa posición es más segura para el nino.

Avaliação polissonográfica do sono e vigília de recém-nascidos prematuros / Evaluación polisomnografíca del sueño y vigilia de bebés prematuros / Polysomnography assessment of sleep and wakefulness in premature newborns

RESUMO Objetivos: descrever o tempo total de sono e seus respectivos estágios, o tempo total de vigília, os valores da frequência cardíaca, de saturação de oxigênio apresentados pelos recém-nascidos prematuros; verificar a influência dos períodos do dia sobre o sono e os parâmetros fisiológicos. Método: estudo descritivo, conduzido com 13 recém-nascidos prematuros hospitalizados. A coleta de dados foi realizada pelo polissonígrafo e a observação não estruturada, durante 24 horas ininterruptas. Resultados: os recém-nascidos permaneceram 59,6% do dia dormindo, predominantemente em sono quieto, apresentando maior média de frequência cardíaca durante a vigília (p<0,001). Não foi evidenciada diferença entre as variáveis relativas ao sono, parâmetros fisiológicos e os períodos do dia. No período matutino houve predominância do sono quieto (p=0,002). Conclusão: os prematuros tiveram maior tempo total de sono do que vigília, o sono quieto foi o estágio predominante e a frequência cardíaca apresentou-se mais elevada durante a vigília.

RESUMEN Objectivo: describir el tiempo total de sueño y sus estagios, el tiempo total de vigilia, los valores de frecuencia cardiaca y saturación de oxígeno presentado por los bebés prematuros, y la influencia de los períodos del día sobre el sueño y los parámetros fisiológicos. Método: estudio descriptivo, realizado con 13 recien nacidos prematuros hospitalizados. La recolección de datos se realizó mediante polisomnografía y la observación no estructurada durante 24 horas, ininterrumpidamente. Resultados: se encontró que los recién nacidos permanecían 59,6% del día durmiendo, predominantemente en el sueño tranquilo, con una mayor frecuencia cardíaca media mientras estaba despierto (p<0,001). No se encontró diferencia entre las variables relacionadas con el sueño, los parámetros fisiológicos y períodos del día, pero por la mañana hubo un predominio de sueño tranquilo (p=0,002). Conclusión: el prematuros tuvieran más tiempo de sueño total que vigilia, el sueño tranquilo fue el estagio predominante y la frecuencia cardíaca fue mayor durante la vigília.

ABSTRACT Objective: to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. Method: a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. Results: the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). Conclusion: the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Conceptual validation of the defining characteristics of respiratory nursing diagnoses in neonates / Validação conceitual das características definidoras de diagnósticos de enfermagem respiratórios em neonatos

OBJECTIVE: To develop and validate conceptual and operational definitions for the defining characteristics of the respiratory nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation, in newborns. METHODS: This was a methodological study of conceptual validation of the defining characteristics of three respiratory nursing diagnoses, by consensus analysis of a committee of five specialist nurses, and then a group of five non-nursing professionals, using the Delphi technique. RESULTS: After two rounds of evaluation, consensus was obtained that was equal to or greater than 80% on all of the definitions, which were then considered validated. CONCLUSION: The definitions developed for the defining characteristics of three nursing diagnoses were validated with a high level of consensus. .

OBJETIVO: Elaborar e validar definições conceituais e operacionais para as características definidoras dos diagnósticos de enfermagem respiratórios, Padrão Respiratório Ineficaz, Troca de Gases Prejudicada e Ventilação Espontânea Prejudicada em recém-nascidos. MÉTODOS: Estudo metodológico, de validação conceitual das características definidoras dos três diagnósticos de enfermagem respiratórios por meio da análise de consenso de um comitê de cinco enfermeiras especialistas e de cinco profissionais não enfermeiros, utilizando a técnica Delphi. RESULTADOS: Após duas rodadas de avaliação, obteve-se consenso igual ou superior a 80% na totalidade das definições, sendo consideradas validadas. CONCLUSÃO: As definições elaboradas para as características definidoras dos três diagnósticos de enfermagem foram validadas com elevado grau de consenso. .

[Perceptions of newborns' families about the communication of bad news]. / Percepções da família do recém-nascido hospitalizado sobre a comunicação de más notícias.

The present study aims to describe how families perceive the communication of bad news about hospitalized newborns given by professionals. A qualitative and descriptive study was carried out with families of hospitalized newborns in the neonatal unit. Five mothers and one father were interviewed The thematic analysis of data revealed four categories: Message content in relation to clarity, detailing and not disclosed information. The way the news was transmitted: leads to ambiguity in reactions. Families' perceptions aboutprofessionals' attitudes to transmit the news: sometimes attitudes are different depending on the professional's experience and involvement with the customer. Use of communication strategies for message transmission: considered by the families as a mean to minimize the gravity of the baby's problem. The results pointed out the use of a non symmetrical communication between professional-family The adoption of a team practice, which incorporates it in its interventions, may meet the families' needs of information and social support.

O perfil sócio-demográfico do cliente adulto do Hospital São Paulo / Demographic and socioeconomic profile of adult clients of the Hospital São Paulo

Este estudo teve por objetivos identificar o perfil socioeconômico-demográfico dos clientes adultos do Hospital São Paulo (HSP), verificar se existem diferenças entre os clientes internados e ambulatoriais, e conhecer suas opiniões quanto ao atendimento recebido. Foram entrevistados 1.124 clientes sendo 473 de ambulatório e 651 de unidades de internação do HSP no segundo semestre de 1998. A pesquisa foi realizada por alunos do primeiro ano do Curso de Graduação de Medicina, por meio de um modelo de entrevista elaborado pelos autores deste estudo. Foram excluídas deste estudo as unidades intensivas, pediátricas e psiquiátricas. Os dados obtidos foram tratados quantitativamente e, para comparação dos grupos de pacientes, foram utilizadas provas estatísticas não paramétricas. Os resultados obtidos permitiram concluir que a metade dos clientes entrevistados eram do sexo feminino e procedentes da zona sul seguida da zona leste, tinham idade entre 20 e 50 anos, estavam empregados, possuíam casa própria e a renda familiar situava-se entre 3 e 6 salários mínimos. Não existiu grande diferença entre os clientes internados e os do ambulatório, sendo estatisticamente significante o grande número de clientes novos entre os internados. A avaliação do atendimento do hospital foi boa para cerca de 90 por cento dos entre-vistados. O maior número de críticas referiu-se ao atendimento ambulatorial e a maior parte dos elogios foi dirigida à excelência de alguns setores e à competência da equipe médica.