Development of Neonatal Sleep -- Importance to Nurse Caregiving and Impact on Infant Outcomes: An Expert Interview With Debra Brandon, PhD, RN, CCNS

Elizabeth McGann, DNSc, RN

September 27, 2010

September 27, 2010 — Editor's note: Sleep and the promotion of sleep development are essential for the health and development of preterm and high-risk infants. A discussion of this topic was featured at the National Association of Neonatal Nurses 26th Annual Educational Conference, held September 19 to 22 in Las Vegas, Nevada

To find out more about neonatal sleep, Medscape Medical News interviewed Debra Brandon, PhD, RN, CCNS, who has more than 30 years of experience in neonatal nursing. Dr. Brandon is a professor at Duke University in Durham, North Carolina, and is associate professor in pediatrics and clinical specialist at Duke University Hospital.

Medscape: What is known about neonatal sleep–wake states and neonatal sleep behavior?

Dr. Brandon: Neonatal sleep is characterized by more active sleep and transitional (indeterminate) sleep than quiet sleep or waking states. During the sleep–wake transition, the infant shows behaviors of both wakefulness and sleep. There is generalized motor activity, and although the eyes are typically closed, they may open and close rapidly. Brief fussy vocalization may occur. During active sleep, the infant's eyes are closed. Respiration is even and primarily costal in nature. Sporadic motor movements occur, but muscle tone is low between these movements. Rapid eye movements occur intermittently in this state. During quiet sleep, the infant's eyes are closed and respiration is relatively regular and abdominal. A tonic level of motor tone is maintained, and motor activity is limited to occasional startles, sighs, or other brief discharges.

Medscape: Are there sleep pattern differences between full-term and premature infants?

Dr. Brandon: Preterm infant's have delayed maturation of a circadian sleep pattern, hypothesized to be, in part, secondary to the highly unpredictable newborn intensive care unit environment.

Medscape: How do caregiving stimulation and interventions and the nursery environment affect infant outcomes?

Dr. Brandon: Caregiving that is individualized to the infant's sleep states and behavioral cues can promote positive infant outcomes. High noise levels, noncontingent stimulation, and circadian patterns in the environment have the potential to interfere with infant development.

Medscape: Are there any national guidelines available?

Dr. Brandon: The National Association of Neonatal Nurses sponsored a developmental textbook, coedited by Carol Kenner and Jacquelyn McGrath, entitled Developmental Care of Newborns and Infants (2nd edition; 2010). It is the most comprehensive summary of evidenced-based developmental interventions.

Medscape: What suggestions do you have for staff development and the implementation of evidence-based protocols around neonatal sleep?

Dr. Brandon: Assess the infant's state and readiness for caregiving, such as feeding, prior to beginning care. Do not interrupt infant quiet sleep for care interventions. Utilize strategies to promote sleep development, such as day–night cycling of low-intensity light (<700 lux) and avoiding care interventions between 10 pm and 6 am to the extent possible, for example bathing and daily weights.

Medscape: What is the most important take-home point?

Dr. Brandon: Sleep and the promotion of sleep development is essential for the health and development of preterm and high-risk infants.

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