Behavioral observation differentiates the effects of an intervention to promote sleep in premature infants: a pilot study.
Behavioral observation differentiates the effects of an intervention to promote sleep in premature infants: a pilot study.
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行为观察区分促进早产儿睡眠的干预措施的效果：一项试点研究。
DOI：
10.1097/anc.0000000000000134
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Visscher,MartyO
中科院分区：
文献类型：
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作者：
Lacina,Linda;Casper,Tammy;Dixon,Melodie;Harmeyer,Joann;Haberman,Beth;Alberts,JeffreyR;Simakajornboon,Narong;Visscher,MartyO
目的：睡眠和睡眠状态的持续循环是神经感觉处理、学习和大脑可塑性所必需的。新生儿重症监护环境的许多方面，如常规和侵入性程序的处理、明亮的灯光和噪音，都会造成压力，扰乱行为，并干扰早产儿的睡眠。该研究实证性地调查了对婴儿睡眠状态和行为的30分钟观察是否可以区分相对于传统护理（标准定位，标准婴儿床床垫[SP]）的干预措施，以促进喂养困难的早产儿的睡眠。我们纳入了一项干预措施，以确定该方法区分治疗的能力，并为未来的改进提供基准。干预，构象定位器（CP），轮廓周围的婴儿提供定制的遏制和边界。为了更充分地验证30分钟的观察性睡眠结果，同时进行标准多导睡眠描记术和睡眠结果的2 models.Subjects：在一项随机交叉临床试验中，25名婴儿，31.5±0.6周的胎龄和38.4±0.6周的研究，胃肠道疾病或一般喂养困难，使用每一个干预在一个通宵的新生儿重症监护病房sleepingstudy.Methods：婴儿睡眠状态和行为进行了观察，在两个30分钟的时间内，也就是说，在定位器和床垫，使用自然观察新生儿的行为。两名经过认证的发育护理护士在2分钟的时间间隔内评估睡眠状态，自我调节和压力行为，并在30分钟内进行总结。在行为观察时测量标准多导睡眠图的睡眠特征。结果：观察发现，与SP相比，CP婴儿处于警觉、主动清醒或哭泣状态的时间显着减少。手术受试者比未手术婴儿花费更多的时间清醒、主动清醒或哭泣，并表现出更多的行为状态变化。观察到的深度睡眠和安静睡眠的时间百分比与睡眠效率百分比（r= 0.78）和脑电图（EEG）每小时的状态转换较少（r=-0.65）相关。睡眠效率脑电图是更大的CP与SP。结论：CP使睡眠相比，标准床垫（SP）超过30分钟的观察期。通过标准的基于EEG的睡眠技术验证来自行为观察的睡眠状态。睡眠状态的行为观察可能是一个有用的策略来衡量策略的有效性，以促进早产儿的睡眠。手术受试者可能受益于额外的干预措施，以促进睡眠。
Purpose:Sleep and ongoing cycling of sleep states are required for neurosensory processing, learning, and brain plasticity. Many aspects of neonatal intensive care environments such as handling for routine and invasive procedures, bright lighting, and noise can create stress, disrupt behavior, and interfere with sleep in prematurely born infants. The study empirically investigated whether a 30-minute observation of infant sleep states and behavior could differentiate an intervention to promote sleep in premature infants with feeding difficulties relative to conventional care (standard positioning, standard crib mattress [SP]). We included an intervention to determine the ability of the method to discriminate treatments and generate a benchmark for future improvements. The intervention, a conformational positioner (CP), is contoured around the infant to provide customized containment and boundaries. To more fully verify the 30-minute observational sleep results, standard polysomnography was conducted simultaneously and sleep outcomes for the 2 modalities were compared.Subjects:In a randomized crossover clinical trial, 25 infants, 31.5±0.6 weeks' gestational age and 38.4±0.6 weeks at the study, with gastrointestinal conditions or general feeding difficulties used each intervention during an overnight neonatal intensive care unit sleep study.Methods:Infant sleep states and behaviors were observed during two 30-minute periods—that is, on the positioner and mattress—using the naturalistic observation of newborn behavior. Two certified developmental care nurses assessed sleep state, self-regulatory, and stress behaviors during 2-minute intervals and summed over 30 minutes. Sleep characteristics from standard polysomnography were measured at the time of behavior observations.Results:Infants on CP spent significantly less time in alert, active awake, or crying states by observation compared with SP. Surgical subjects spent more time awake, active awake, or crying and displayed a higher number of behavior state changes than the nonsurgical infants. The percentage of time in observed deep sleep and quiet sleep was correlated with both percentage sleep efficiency (r= 0.78) and fewer state shifts per hour (r=− 0.65) from electroencephalogram (EEG). Sleep efficiency by EEG was greater on CP versus SP.Conclusions:The CP enabled sleep compared with the standard mattress (SP) over 30-minute observation periods. Sleep status from behavioral observation was verified by standard EEG-based sleep techniques. Behavioral observation of sleep states may be a useful strategy for measuring the effectiveness of strategies to facilitate sleep in premature infants. Surgical subjects may benefit from additional interventions to promote sleep.