Safeguarding Sleep -- Value in Neuroprotection of the Newborn
Safeguarding Sleep -- Value in Neuroprotection of the Newborn
Care that nurtures infants promotes sleep. Skin-to-skin care, family integrated care, and developmental care are concepts that have been shown to improve both infant sleep and long-term outcome, but our understanding of how best to implement these practices and how their beneficial effects can be maximized is still limited, probably in large part because our outcome measures are so far removed from the interventions. Without real-time biochemical, physical, and imaging measures of brain health and development, it is hard to know which aspects of these interventions we should emphasize the most. Relevant to this discussion, it is particularly difficult to know the value of protecting sleep versus providing nurturing stimuli — although knowing that infants can learn during sleep makes it less important to view these as dichotomous states.
Many structural and operational strategies can be implemented to minimize noxious stimuli and promote sleep.
In the future, we should seek better ways to understand and visualize the sleep process in high-risk infants. Continuous EEG devices that are easily interpreted and not obtrusive are being developed, as are additional techniques to understand brain activity and function under various conditions and in response to various treatments. In the meantime, low-tech strategies such as noise and light reduction, parent care, and avoiding unnecessary sleep interruptions for routine caregiving needs should be recognized as important methods of neuroprotection in the NICU.
Strategies to Safeguard Sleep and Especially Its Neuroprotective Benefits
Care that nurtures infants promotes sleep. Skin-to-skin care, family integrated care, and developmental care are concepts that have been shown to improve both infant sleep and long-term outcome, but our understanding of how best to implement these practices and how their beneficial effects can be maximized is still limited, probably in large part because our outcome measures are so far removed from the interventions. Without real-time biochemical, physical, and imaging measures of brain health and development, it is hard to know which aspects of these interventions we should emphasize the most. Relevant to this discussion, it is particularly difficult to know the value of protecting sleep versus providing nurturing stimuli — although knowing that infants can learn during sleep makes it less important to view these as dichotomous states.
Many structural and operational strategies can be implemented to minimize noxious stimuli and promote sleep.
Single-family rooms — Single-family rooms have the potential to enhance infant sleep and outcomes, but only if they increase the likelihood that the family will be present.
Noise control — Infant sleep is affected adversely by high ambient noise levels, and by episodic noises, even when ambient levels are low. There are many strategies to reduce noise levels within existing units, but these are often limited by the existing building infrastructure.
Soothing auditory stimuli — For most people, total silence is not the optimal sleep environment, and babies are probably no different. Studies using music, maternal voice and heartbeat, and other soothing sounds are intriguing. Most have been done with small sample sizes, but it seems likely that future research will establish their value.
Light control — Most NICUs are no longer exposing infants to continuously bright ambient light, but continuous dim lighting is not optimal, either. Cycled ambient lighting and protecting infants from inadvertent exposure to bright lights will protect sleep.
Clustered care — While the concept is logical, this may be the most problematic method to protect sleep, largely because in the highest-risk infants, sleep cycles are indeterminate and care needs are often impossible to defer. Nevertheless, policies that encourage caregivers to postpone interventions that are not time-crucial until the infant is awake should be encouraged.
In the future, we should seek better ways to understand and visualize the sleep process in high-risk infants. Continuous EEG devices that are easily interpreted and not obtrusive are being developed, as are additional techniques to understand brain activity and function under various conditions and in response to various treatments. In the meantime, low-tech strategies such as noise and light reduction, parent care, and avoiding unnecessary sleep interruptions for routine caregiving needs should be recognized as important methods of neuroprotection in the NICU.
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