title: Sleep-wake cycling in a neonate admitted to the NICU: a video-EEG case study during hypothermia treatment.
abstract: This retrospective case study describes the sleep-wake cycles of an infant in the neonatal intensive care unit. We analyzed video-electroencephalographic recording of the term infant monitored during treatment with therapeutic hypothermia for hypoxic-ischemic encephalopathy. The continuous video-electroencephalographic recording over a 4-day period also allowed us to describe the following dimensions of daily care in relation to the infant's sleep-wake states: (1) handling by professional and parent caregivers and (2) stress, pain, and analgesia. Physical contact constituted 17% to 36% of each 24-hour period. The infant's care was fragmented, with a mean of 3 to 4 physical contacts per hour. As a result, the structure of infant sleep was altered by the increased amount of awake and quiet sleep. The number of painful procedures ranged from 5 to 24 per day. Nurses were the main care providers. Parents had more contact after the infant was rewarmed. This case study suggests that neonatal intensive care unit infants are exposed to frequent handling and stress as well as altered sleep. The cumulative negative impact of frequent handling and sleep fragmentation may go unnoticed by caregivers focused on episodes of care. Continuous video-electroencephalographic monitoring is a useful tool for longitudinal evaluation of infant sleep and responses to caregiving in the neonatal intensive care unit.
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco, USA. Anna.Axelin@utu.fi
authors.forename: Anna
authors.initials: A
authors.lastname: Axelin
authors.forename: Maria Roberta
authors.initials: MR
authors.lastname: Cilio
authors.forename: Marilisa
authors.initials: M
authors.lastname: Asunis
authors.forename: Susan
authors.initials: S
authors.lastname: Peloquin
authors.forename: Linda S
authors.initials: LS
authors.lastname: Franck
mesh_terms: D001034:Apgar Score; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D012894:Sleep Stages / Q000502:physiology*; D013315:Stress, Psychological; D016896:Treatment Outcome; D014741:Video Recording; D014851:Wakefulness / Q000502:physiology