Yenidoğan Yoğun Bakım Ünitelerinde Kaliteli Uyku

Yıl 2015, Cilt: 8 Sayı: 3, 214 - 217, 01.08.2015

Sibel Küçük

Öz

Tüm canlılar gibi yenidoğanlar için de uyku gerekli ve önemli bir işlevdir ve yenidoğanların Yoğun Bakım Ünitelerinde tedavi edilmeleri durumunda düzeyi ve kalitesi olumsuz etkilenebilmektedir. Korunaklı bir alandan oldukça gürültülü ve hareketli olan yoğun bakım ünitesine geçiş yenidoğanları oldukça etkileyen önemli bir olaydır. YYBÜ’lerinin özellikle ses ve ışık düzeyleri yenidoğanlarda çeşitli fizyolojik ve gelişimsel sorunlara yol açabilmektedir ki yenidoğan preterm ise bu sorunlar daha da belirgin olabilmektedir. Uygun olmayan sürekli ses ve ışık düzeyi yenidoğanın gece gündüz döngüsünü bozarak beslenme, vücut stabilitesini etkilemekte ve dolayısıyla büyüme ve gelişme üzerinde olumsuz etkiler yaratmaktadır. Yoğun Bakım Ünitelerde gece gündüz döngüsünün oluşturulması, ışık şiddetinin ayarlanması, yüksek ses düzeyinin uygun standartlara getirilmesi gibi temel önlemlerin yanı sıra uyku pozisyonlarının düzenlenmesi, yenidoğan masajı uygulanması ve girişimsel ve bakıma ait işlemlerin uyku saatlerinin göz önüne alınarak uygulanması, bebeğe yeterli ve etkili dinlenme saatleri bırakılması gibi önlemler yenidoğanın uyku kalitesini arttırarak büyüme ve gelişmeyi destekleyebilmektedir. YYBÜ’lerinde ışık şiddetinin gündüz 580, gece 30 lux’ü, ortalama ses düzeyinin ise 50 dB’i geçmemesi alınması gereken standart tedbirler içerisinde yer almalıdır. Küvöz ve ışıklı aletlerin üzerlerinin örtülmesi, göz petlerinin kullanılması gibi uygulamalar da uyku kalitesini arttırabilecektir. Ayrıca yenidoğan masajı ve uyku kalitesini arttıracak pozisyon uygulamaları rutin bakım protokolleri arasında alınmalı ve masajın dokunsal uyanlarla gece gündüz döngüsünün olgunlaşmasına katkıda bulunulabileceği, hastanede kalış sürelerinin de azaltılabileceği unutulmamalıdır. YYBÜ’lerinde alınacak belirli ve basit önlemler tedavi ortamından kaynaklanan olumsuzlukları en aza indirmeye yardımcı olabilir. Ünitelerde uyku kalitesini arttıracak önlemlerin standardize edilmesi, kurumsal ve evrensel tedbirlerin alınması, personelin özellikle hemşirelerin konu hakkında bilgilendirilmesi ise ayrıca önem taşımaktadır.

Anahtar Kelimeler

Yenidoğan, Yoğun bakım, Uyku

Quality Sleep In Neonatal Intensive Care Unit

Öz

Sleep is a required and important function for newborns and its level and quality could be effected negatively at
intensive care units (ICU). Passing to noisy and active unit from a confident area is very important event that effects
newborns. Sound and light levels of ICU cause some physiological and developmental problems in newborns and also for
preterms, these problems are more significant. Inappropriate sound and light disrupt day-night cycle, affects body stability and
create negative effects on their growth and development .Besides creating day-night cycle, setting suitable standards for high
sound and light level; setting sleep positions, massage and doing the care interventions by considering sleep time, giving
enough and effective time for rest could be supportive for their growth and development by increasing quality of sleep. Light
degree should be 580 luxes at daytime, 30 luxes at nights, average sound level should not be over than 50 dB at ICU. Covering
the incubators and equipments with light, using eye bandages could increase the quality of sleep. Also, newborn massage and
position practices for qualified sleep should be taken in routine care protocols and it should not be forgotten that massage could
contribute to compose day-nigth cycle and decrease duration of staying at hospital. Certain and easy measures could decrease
negative effects of treatment environment at ICU. Also, it is very important to do standard measures that increase sleep quality,
take instituional and universal measures, give information to the personel especially nurses.

Anahtar Kelimeler

Newborn, Intensive care, Sleep

Kaynakça

• ara Begum E, Bonno M, Obata M & et al. Emergence of physiological rhythmicity in term and preterm neonates in a neonatal intensive care unit. Journal of Circadian Rhythms 2006; 4: 11. doi:10.1186/1740-3391-4-11
• Als H, Lawhon G, Brown E & et al. Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: Neonatal in intensive care unit and developmental outcome. Pediatrics 1986; 78: 1123-32.
• Aly FF, Murtaza G. Massage Therapy in Preterm Infants. Pediatrics & Therapeutics, 2013; 3: 155. doi:10.4172/2161-0665.1000155
• American Academy of Pediatrics; American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2002.
• American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics. 2007; 120 (4): 898-921.
• Ariagno RL, Mirmiran M, Adams MM & et al. Effect of position on sleep, heart rate variability, and QT interval in preterm infants at 1 and 3 months’ corrected age. Pediatrics 2003; 111: 622-5. doi: 10.1542/peds.111.3.622
• Aris C, Stevens TP, Lemura C & et al. NICU Nurses’ knowledge and discharge teaching related to ınfant sleep position and risk of SIDS. Advances in Neonatal Care. 2006; 6 (5); 281-94. doi: 10.1016/j.adnc.2006.06.009
• Aucott S, Donohue PK, Atkins E & et al. Neurodevelopmental Care in NICU. Ment Retard Dev Disabil Res 2002; 8 (4): 298-308. PMID:12454906 Blackburn S. Environmental impact of the NICU on developmental outcomes. J Pediatr Nurs 1998; 13: 279- 89.
• Blair P, Ward Platt MP, Smith IJ & et al. Sudden infant death syndrome and sleeping position in preterm and low birth weight infants: an opportunity for targeted intervention. Arch Dis Child 2006; 91: 101-6. doi:10.1136/adc.2004.070391
• Brandon DH, Holditch-Davis D, Belyea M. Preterm infants born at less than 31 weeks’ gestation have improved growth in cycled light compared with continuous near darkness. Journal of Pediatrics 2002; 140 (2): 192-9. doi:10.1067/mpd.2002.121932
• Brenner RA, Simons-Morton BG, Bhaskar B & et al. Prevalence and predictors of the prone sleep position among inner-city infants. JAMA 1998; 280: 341-6. doi:10.1001/jama.280.4.341
• Buehler DM, Als H, Duffy FH & et al. Effectiveness of individualized developmental care for low risk preterm infants: Behavioral and electrophysiologic evidence. Pediatrics 1995; 96: 923-32.
• Bullock LF, Mickey K, Green J & et al. Are nurses acting as role models for the prevention of SIDS. Am J Matern Child Nurs 2004; 29: 172-7.
• Çevre ve Orman Bakanlığı. Bazı gürültü değerleri ve etkileri.
• http://gurultu.cevreorman.gov.tr/gurultu/AnaSayfa/gur ultu/gurultudegerleri.aspx?sflang=tr. Erişim: 03.03.2015
• Darmstadt CL, Mao-Qiang M, Chi E. & et al. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing vountries. Acla Paediatrica 2002; 91(5): 546-554. doi:10.1111/j.1651- 2227.2002.tb03275.x
• Diego MA, Field T, Hernandez-Reif M. Vagal Activity, Gastric Motility, and Weight Gain in Massaged Preterm Neonates. The Journal of Pediatrics 2005, 147(1); 50-5. doi:10.1016/j.jpeds.2005.02.023.
• Ferber SG, Feldman R, Kohelet D & et al. Massage therapy facilities mother-infant interaction in premature infants. Infant Behav Dev 2005; 28: 74-81. doi:10.1016/j.infbeh.2004.07.004
• Field T, Schanberg S, Davalos M & et al. Massage with oil has more positive effects on normal infants. Pre and Perinatal Psychology Journal 1996; 11(2): 75-80. https://www.questia.com/library/journal/1P3-
• 1380680011/massage-with-oil-has-more-positiveeffects-on-normal Gerhardt KJ, Abrams RM, Oliver CC. Sound environment of the fetal sheep. Am J Obstet Gynecol 1990; 80: 186- 90. doi: http://dx.doi.org/10.1016/0002- 9378(90)90866-6
• Goto K, Mirmiran M, Adams MM & et al. More awakenings and heart rate variability during supine sleep in preterm infants. Pediatrics 1999; 103: 603-9.
• Guilleminault C. The Polysomnographic Evaluation of Sleep Disorder. In: Aminoff MJ, editor. Electrodiagnosis in Clinical Neurology, 3rd ed. New York: Churchill Livingstone USA; 1992. 711-36.
• Hourihane J, Bedwani S, Dean T, Warner J. Randomised, double blind, crossover challenge study of allergenicity of peanut oils in subjects allergic to peanuts. British Medical journal 1997; 314: 1081-1087. doi: http://dx.doi.org/10.1136/bmj.314.7087.1084.
• Kennaway DJ, Stamp GE, Goble FC. Development of melatonin production in infants and the impact of prematurity. The Journal of Clinical Endocrinology and Metabolism 1992; 75: 367-9.
• Livingstone K, Beider S, Kont AJ & et al. Touch and massage for medically fragile infants. Evid Based Complement Alternat Med 2007; 6 (4): 473-82.
• http://dx.doi.org/10.1093/ecam/nem076 Long JG, Lucey JF, Philip AGS. Noise and hypoxemia in the intensive care nursery. Pediatrics 1980; 65 (1): 143- 5.
• Lotas MJ. Effects of light and sound in the neonatal intensive care unit environment on the low-birthweight infant. NAACOG’s Clin Issues Perinat Womens Health Nurs 1992; 3: 34-44.
• Mann NP, Haddow R, Stokes L & et al. Effect of night and day on preterm infants in a newborn infants: randomised trial. BMJ 1986; 293:1265-7.
• Morag I, Ohlsson A. Cycled light in the intensive care unit for preterm and low birth weight infants. Cochrane Database Syst Rev 2011; 1: CD006982.
• Morris BH, Philbin MK, Bose C. Physiological effects of sound on the newborn. J Perinatol 2000; 20 (Suppl): 54-9.
• Obeidat H, Kahalaf I, Callister L & et al. Use of facilitated tucking for nonpharmacological pain managment in preterm infants: A systematic review. Journal of Perinatal & Neonatal Nursing 2009; 23(4): 372-7.
• Oyen N, Markstad T, Skaerven R & et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics 1997; 100: 613-21.
• Öztürk L. Yanıtını Arayan Eski Bir Soru: Niçin Uyuruz? İstanbul Tıp Fakültesi Dergisi 2007; 70 (4): 114-21.
• Rivkees SA. Developing circadian rhythmicity in infants. Pediatrics 2003; 112: 373-81.
• Rivkees SA, Hao H. Developing circadian rhythmicity. Semin Perinatol 2000; 24: 232-42.
• Sehgal A, Stack J. Developmentally supportive care and NIDCAP. Indian J Pediatr 2006; 73 (11): 1007-110.
• Sizun F, Westrup B. Early developmental care of preterm neonates: a call for more research. Arch Dis Child Fetal Neonatal Ed 2004; 89: 384-9. doi:10.1136/adc.2003.034454.
• Thoman EB, Ingersoll EW. The human nature of the youngest human: prematurely born babies. Seminars in Perinatology 1989; 13: 482-94.
• Vanderburg KA. Individualized developmental care for high risk newborns in the NICU: A practice guideline. Early Hum Dev 2007; 83 (7): 433-42. doi: http://dx.doi.org/10.1016/j.earlhumdev.2007.03.008).
• Vickers A, Ohlsson A, Lacy JB & et al. Massage for promoting growth and development of preterm and/or low birth weight infants. Cochrane Database Syst Rev 2004. doi: 10.1002/14651858.CD000390.pub2
• Wielenga JM, Smit BJ, Merkus MP & et al. Development and growth in very preterm infants in relation to NIDCAP in a Dutch NICU: two years of follow-up. Acta Paediatr 2009; 98 (2): 291-7.
• World Health Organization (WHO). Guidelines for Community Noise. Noise sources and their measurement. 1999. http://www. who.int/docstore/peh/noise/guidelines2.html. Erişim 02.02.2015
• Zahr L. Two contrasting NICU environments. MCN Am J Matern Child Nurs 1998; 23: 28-36.
• Zahr L, Balian S. Responses of premature infants to routine nursing interventions and noise in the NICU. Nurs Res 1995; 44(3): 179-85.