Lan Hsiang-Yun, Yang Luke, Hsieh Kao-Hsian, Yin Ti, Chang Yue-Cune, Liaw Jen-Jiuan
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
School of Nursing, National Defense Medical Center, Taipei, Taiwan.
Res Nurs Health. 2018 Jun;41(3):281-291. doi: 10.1002/nur.21865. Epub 2018 Apr 20.
Sleep is important for preterm infants' brain development, but they are frequently exposed to painful procedures in the neonatal intensive care unit (NICU) that disturb their sleep cycle and affect their growth. The purpose of this study was to examine the prolonged effects of a supportive care bundle (modulation of the infants' states, non-nutritive sucking, facilitated tucking, and oral sucrose feeding) on preterm infants' sleep variables (sleep efficiency, total sleep time, sleep latency, and frequency of wake bouts) during hospitalization. The team recruited 65 preterm infants (gestational age at birth 28-36 weeks, average birth weight 1,652 g) from a Level III NICU at a medical center in Taiwan. Infants were randomly assigned to one of two treatment conditions to be administered while receiving intrusive procedures: (1) control condition (usual care, including routine procedures, positioning, and gentle touch); or (2) intervention condition in which the supportive care bundle was added to usual care. Sleep variables were measured using actigraphy for a baseline of three continuous days on the 6th to 8th days after birth and again for 3 continuous days when infants weighed ≧1,950 g. Two forms of generalized estimating equation analyses with control of significant covariates were used for data analysis. The supportive care bundle not only significantly increased sleep efficiency and total sleep time but also significantly decreased duration of sleep latency and frequency of wake bouts. These results provide evidence to support the incorporation of the supportive care bundle into NICU clinical practice during intrusive procedures.
睡眠对早产儿的大脑发育很重要，但他们在新生儿重症监护病房（NICU）经常要接受痛苦的操作，这会扰乱他们的睡眠周期并影响其生长。本研究的目的是探讨一种支持性护理方案（调节婴儿状态、非营养性吸吮、舒适包裹和口服蔗糖喂养）对住院期间早产儿睡眠变量（睡眠效率、总睡眠时间、睡眠潜伏期和觉醒发作频率）的长期影响。研究团队从台湾一家医疗中心的三级新生儿重症监护病房招募了65名早产儿（出生时孕周28 - 36周，平均出生体重1652克）。婴儿在接受侵入性操作时被随机分配到两种治疗条件之一：（1）对照条件（常规护理，包括常规操作、体位摆放和轻柔触摸）；或（2）干预条件，即在常规护理基础上增加支持性护理方案。在出生后第6至8天连续三天使用活动记录仪测量睡眠变量作为基线，当婴儿体重≥1950克时再次连续三天测量。数据分析采用两种控制显著协变量的广义估计方程分析形式。支持性护理方案不仅显著提高了睡眠效率和总睡眠时间，还显著缩短了睡眠潜伏期和减少了觉醒发作频率。这些结果为在侵入性操作期间将支持性护理方案纳入新生儿重症监护病房临床实践提供了证据支持。
