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A proteção do sono do recém-nascido pré-termo e de termo nas unidades de cuidados intensivos neonatais: modelo touchpoints
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Abstract(s)
O sono é o principal estado comportamental no período neonatal.
Os recém-nascidos (RN) não apresentam um padrão circadiano, presumindo-se
uma ritmação por sincronização com a prestação de cuidados. A capacidade de atingirem
um estado de transição sugestivo de adormecimento tem que ver com uma capacidade
temporalmente dependente de marcos de desenvolvimento relativos a conexões neuronais
expressas em respostas comportamentais comprometidas pela estimulação sensorial
excessiva observada em ambiente de cuidados intensivos, indutora de privação do sono.
Efetuou-se um estudo observacional, longitudinal, correlacional e prospetivo, de
abordagem quantitativa, que pretendeu avaliar o sono dos RN por uma análise
biocomportamental tendo em conta as etapas de neurodesenvolvimento do RN pré-termo
e de termo. Estes, foram avaliados mediante a sua estabilidade autónoma e fisiológica,
regulação motora, organização de estados, que culminaram na capacidade de resposta ao
meio que os envolvia traduzida por um padrão de sono. Face aos estímulos a que
estiveram sujeitos ao longo do tempo de internamento, foram considerados touchpoints
no crescimento e desenvolvimento.
A amostra do estudo incluiu 62 RN internados numa Unidade de Cuidados
Intensivos Neonatais (UCIN) de um Hospital de Lisboa. Para recolha de dados, utilizouse uma grelha de observação que avaliou o sono dos RN quanto ao estado
comportamental, posicionamento, necessidade de ventilação, alimentação, manipulação
e exposição a ruído e luminosidade.
Os resultados foram significativos no que concerne à influência do ruído no tempo
de sono, tendo em conta a idade gestacional (IG). Por outro lado, demonstrou-se não
existir correlação entre a resposta comportamental, perante fatores stressores, e a idade
gestacional; que nem o posicionamento, nem a ventilação, influenciam o tempo de sono;
que a forma de administração da alimentação não impacta no tempo de sono, e que não
existe relação direta entre o seu tipo e o tempo até se atingir o estado de transição.
Concluiu-se que é perentório existirem avaliações individuais das capacidades do
RN pré-termo e de termo para lidarem com a estimulação excessiva a que ficam sujeitos
nas UCIN, com efeito direto na proteção do seu sono.
Sleep is the predominant behavioural state during neonatal period. Newborns (RN) do not show a circadian sleep pattern, so it is assumed that they synchronize it with the period their care takes place. Their capacity to reach a transitional state suggestive of sleep is connected to the developmental of neuronal connections, unfolded by their behavioural responses. Those responses are compromised by the overstimulation observed in an intensive care environment which can lead to sleep deprivation An observational, longitudinal, correlational and prospective study has been done in order to quantitatively evaluate the newborn’s sleep pattern via a biobehavioral analysis, having in consideration preterm and term neurodevelopmental milestones. Both were evaluated taking into account their autonomous and physiological stability, motor regulation and states of alertness, and how those impacted in their capacity to respond to the surrounding environment and ultimately in their sleep pattern. Growth and developmental touchpoints were considered when observing their response to the stimuli presented during their admission to the neonatal unit. This study sample includes 62 newborns admitted to an Intensive Care Neonatal Unit (UCIN) in Lisbon. Data were collected with an observation grid which evaluated newborns’ sleep quality, including their behavioural state, positioning, need for ventilation, feeding, handling and exposure to light and sound. Results obtained show the major impact noise has on the quality and duration of sleep, considering newborns’ gestational age. On the other hand, results show no correlation between newborns’ behavioural response when exposed to a stressful stimuli and their gestational age; neither positioning, nor ventilation affect the time of sleep; feeding technique has no impact on the time of sleep; feeding type is not related to how long it takes to reach a transition state. In conclusion, it is highlighted that an individualized assessment of both preterm and term newborns is paramount to assess their ability to deal with the overstimulation presented in an UCIN, protecting hence their sleep.
Sleep is the predominant behavioural state during neonatal period. Newborns (RN) do not show a circadian sleep pattern, so it is assumed that they synchronize it with the period their care takes place. Their capacity to reach a transitional state suggestive of sleep is connected to the developmental of neuronal connections, unfolded by their behavioural responses. Those responses are compromised by the overstimulation observed in an intensive care environment which can lead to sleep deprivation An observational, longitudinal, correlational and prospective study has been done in order to quantitatively evaluate the newborn’s sleep pattern via a biobehavioral analysis, having in consideration preterm and term neurodevelopmental milestones. Both were evaluated taking into account their autonomous and physiological stability, motor regulation and states of alertness, and how those impacted in their capacity to respond to the surrounding environment and ultimately in their sleep pattern. Growth and developmental touchpoints were considered when observing their response to the stimuli presented during their admission to the neonatal unit. This study sample includes 62 newborns admitted to an Intensive Care Neonatal Unit (UCIN) in Lisbon. Data were collected with an observation grid which evaluated newborns’ sleep quality, including their behavioural state, positioning, need for ventilation, feeding, handling and exposure to light and sound. Results obtained show the major impact noise has on the quality and duration of sleep, considering newborns’ gestational age. On the other hand, results show no correlation between newborns’ behavioural response when exposed to a stressful stimuli and their gestational age; neither positioning, nor ventilation affect the time of sleep; feeding technique has no impact on the time of sleep; feeding type is not related to how long it takes to reach a transition state. In conclusion, it is highlighted that an individualized assessment of both preterm and term newborns is paramount to assess their ability to deal with the overstimulation presented in an UCIN, protecting hence their sleep.
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Keywords
recém-nascido prematuro sono unidade de cuidados intensivos neonatais newborn premature sleep neonatal intensive care units newborn intensive care units