Yenidoğan Döneminde Bebek Uykusunun Özellikleri ve Ebelerin Rolü: Güncel Kanıtlar Üzerine Bir Derleme

Öz

Bu derleme çalışması, yenidoğan döneminde bebeklerin uyku özelliklerini ve bu süreçte ebelik hizmetlerinin rolünü güncel kanıtlar ışığında incelemeyi amaçlamaktadır. Yenidoğanlar, yaşamın ilk 28 gününde uykunun fizyolojik, nörolojik ve davranışsal gelişim üzerindeki belirleyici etkilerine bağlı olarak, yoğun bir uyku süreci yaşarlar. Uyku, bu dönemde sinaptik bağlantıların oluşumu, bağışıklık sisteminin güçlenmesi ve beyin gelişimi açısından kritik bir işlev taşımaktadır. Derlemede, REM/NREM döngüsü, term ve prematüre bebeklerde uyku farklılıkları, fizyolojik değişimler ve uykuya etki eden çevresel faktörler ayrıntılı biçimde ele alınmıştır. Bununla birlikte, doğum şekli, anne sütüyle beslenme, annenin psikolojik durumu ve ebeveyn etkileşimi gibi faktörlerin bebek uykusuna olan etkileri de değerlendirilmiştir. Ebelik uygulamalarının bebek uykusunu desteklemedeki yeri, emzirme danışmanlığı, kanguru bakımı, bebek masajı, müzik ve ninni temelli müdahaleler gibi non-farmakolojik yöntemler üzerinden tartışılmış; uyku hijyeni eğitimi ve ebe tarafından yürütülen ev ziyaretlerinin önemine vurgu yapılmıştır. Ayrıca, uyku kalitesinin değerlendirilmesinde kullanılan ölçekler ve klinik protokollerin ebelik bakımına entegrasyonu incelenmiştir. Sonuç olarak, yenidoğan uykusunun düzenlenmesinde ebelerin hem klinik hem toplumsal düzeyde üstlendiği koruyucu, eğitici ve rehberlik eden rollerin güçlendirilmesi gerektiği vurgulanmaktadır. Ebelerin aktif katılımıyla yürütülecek çok boyutlu müdahaleler hem bebek sağlığı hem de ebeveyn refahı açısından olumlu katkılar sağlayacaktır.

Anahtar Kelimeler

• Yenidoğan
• Uyku
• Ebelik
• Uyku Hijyeni
• Kanguru Bakımı
• Non-farmakolojik Müdahale

Characteristics of Baby Sleep in the Neonatal Period and the Role of Midwives: A review of current evidence

Öz

This review aims to examine the sleep characteristics of infants during the neonatal period, as well as the role of midwifery services in this process, by drawing on the most up-to-date evidence available. Newborns experience an intense sleep period during the first 28 days of life, which is driven by the significant impact of sleep on physiological, neurological and behavioural development. Sleep is critical during this period for forming synaptic connections, strengthening the immune system and developing the brain. The review provides an in-depth analysis of the REM/NREM cycle, sleep differences between term and premature infants, physiological changes and environmental factors that influence sleep. Furthermore, it evaluates the effects of factors such as mode of birth, breastfeeding, maternal psychological state, and parental interaction on infant sleep. The review discusses the role of midwifery practices in supporting infant sleep through non-pharmacological methods, such as breastfeeding counselling, kangaroo care, baby massage, music and lullaby-based interventions. The importance of sleep hygiene education and midwife-led home visits is emphasised. Additionally, the scales used to evaluate sleep quality and the incorporation of clinical protocols into midwifery care are examined. It is consequently emphasised that the protective, educational and guiding roles of midwives in regulating newborn sleep should be strengthened at both clinical and societal levels. Multifaceted interventions involving the active participation of midwives will have a positive impact on infant health and parental well-being.

Anahtar Kelimeler

• Newborns
• sleep
• midwifery
• sleep hygiene
• kangaroo care
• non-pharmacological intervention

Kaynakça

1. Aghaie, M., Jabraeili, M., Asghari Jafarabadi, M., & Ghojazadeh, M. (2021). The effect of recorded lullaby and live lullaby on oxygen saturation in premature infants: A randomized double-blind clinical trial. Journal of Neonatal Nursing, 27(1), 66–71. https://doi.org/ 10.1016/j.jnn.2019.07.001
2. Akanalçı, C., Bilici, S. (2024). Biological clock and circadian rhythm of breast milk composition. Chronobiology International, 41(8), 1226-1236.
3. Ball, H. L., Taylor, C. E., Thomas, V., Douglas, P. S., SBY Working Group. (2020). Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving. PLoS One, 15(8), e0237240. https://doi.org/10.1371/ journal.pone.0237240
4. Bathory, E., Tomopoulos, S. (2017). Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age children. Current Problems in Pediatric and Adolescent Health Care, 47(2):29-42. https://doi.org/10.1016/ j.cppeds. 2016.12.001
5. Beaugrand, M., Jaramillo, V., Markovic, A., Huber, R., Kohler, M., Schoch, S. F., Kurth, S. (2023). Lack of association between behavioral development and simplified topographical markers of the sleep EEG in infancy. Neurobiology of Sleep and Circadian Rhythms, 15, 100098. https://doi.org/10.1016/j.nbscr.2023.100098
6. Bieleninik, Ł., Ettenberger, M., Epstein, S., Elefant, C., Arnon, S. (2021). Potential psychological and biological mechanisms underlying the effectiveness of neonatal music therapy during kangaroo mother care for preterm infants and their parents. International Journal of Environmental Research and Public Health, 18(16), 8557. https://doi.org/10.3390/ijerph18168557
7. Blumberg, M. S., Seelke, A. M., Lowen, S. B., & Karlsson, K. A. (2020). The developing brain revealed during sleep. Current Opinion in Physiology, 15, 63–70. https://doi.org/10.1016/j.cophys.2019.11.003
8. Boran, P., Barış, H. E., Us, M. C., Barlak, H., Aşkan, Ö. Ö., Teke, Z., Spruyt, K. (2025). Predictors of early childhood insomnia according to parent-rated degree of severity. Sleep Medicine, 127, 138-144. https://doi.org/10.1016/ j.sleep. 2025.01.019

9. Bryanton, J., Gagnon, A. J., Hatem, M., Johnston, C. (2013). Predictors of early parenting self‐efficacy: Results of a prospective cohort study. Nursing Research, 62(4), 258–266. https://doi.org/10.1097/NNR.0b013e318299a669
10. Charpak, N., Tessier, R., Ruiz-Peláez, J. G., Charpak, Y. (2022). Kangaroo mother care had a protective effect on brain volume in premature infants at 20 years of age. Acta Paediatrica, 111(2), 261–268. https://doi.org/10.1111/ apa.16140
11. Cole, R., Young, J., Kearney, L., Thompson, J. M. D. (2020). Infant care practices and parent uptake of safe sleep messages: a cross-sectional survey in Queensland, Australia. BMC Pediatrics, Jan 21;20(1):27. https://doi.org/10.1186/s12887-020-1917-5
12. Conde-Agudelo, A., Díaz-Rossello, J. L. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, (8). https://doi.org/10.1002/14651858. CD002771.pub4
13. Cook, F., Conway, L., Gartland, D., Giallo, R., Keys, E., Brown, S. (2020). Profiles and predictors of infant sleep problems across the first year. Journal of Developmental & Behavioral Pediatrics, 41(2), 104–116. https://doi.org/10.1097/DBP.0000000000000742
14. Çift, T., Arslan, G. G. (2023). The effect of infant massage on sleep quality and crying duration in term newborns: A randomized controlled trial. Journal of Neonatal Nursing, 29(1), 17–23. https://doi.org/10.1016/j.jnn.2022.07.007
15. Çiftçi, E., Demirci, N. (2021). Yenidoğan bakımında ebe rollerinin güncel kanıtlarla incelenmesi. Ebelik ve Kadın Sağlığı Dergisi, 1(2), 45–52.
16. deRegnier, R. A. (2022). Sleep practices after midwife-led births. The Journal of Pediatrics, 248, 4–5. https://doi.org/10.1016/j.jpeds.2022.06.006
17. Feldman-Winter, L., Goldsmith, J. P. Committee on Fetus and Newborn. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics, 138(3), e20161889. https://doi.org/10.1542/peds.2016-1889
18. Grigg-Damberger, M. M. (2016). Sleep in the newborn. Pediatric Clinics of North America, 63(3), 505–518. https://doi.org/10.1016/j.pcl.2016.02.003
19. Haslbeck, F. B., Jakab, A., Held, U., Bassler, D., Bucher, H. U., Hagmann, C. (2020). Creative music therapy for preterm infants improves neurodevelopmental outcomes: A randomized controlled trial. Pediatrics, 145(2), e20192021. https://doi.org/10.1542/peds.2019-2021
20. Hodges, E. A., Luedtke-Hoffmann, K., Bost, J., Sanders, C., Gierisch, J. (2018). Certified nurse–midwives’ knowledge, attitudes, and practices related to safe infant sleep. Journal of Midwifery & Women’s Health, 63(3), 300–306. https://doi.org/10.1111/jmwh.12721
21. International Confederation of Midwives (ICM). (2017). Essential Competencies for Midwifery Practice. https://www.internationalmidwives.org
22. International Confederation of Midwives (ICM). (2021). Care of the newborn: Position statement. Retrieved July 21, 2025, from https://internationalmidwives.org/assets/files/ statement-files/2021/10/icm-care-of-the-newborn-2021-eng.pdf
23. International Confederation of Midwives (ICM). (2023). ICM global standards for midwifery education (2023 update). Retrieved from https://internationalmidwives.org/assets/ files/general-files/2023/07/icm-standards-guidelines-2023-final.pdf
24. Korotchikova, I., Ryan, C. A., Boylan, G. B. (2012). 1079 Sleep-Wake cycling in healthy term newborn infants in the immediate postnatal period. Archives of Disease in Childhood, 97(Suppl 2), A309-A310. https://doi.org/ 10.1016/j.clinph.2015.12.015
25. Landsem, I. P., Cheetham, N. B. (2022). Infant sleep as a topic in healthcare guidance of parents, prenatally and the first 6 months after birth: a scoping review. BMC Health Services Research, 22(1), 1135. https://doi.org/ 10.1186/s12913-022-08484-3
26. Loewy, J., Stewart, K., Dassler, A. M., Telsey, A., Homel, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131(5), 902–918. https://doi.org/10.1542/peds.2012-1367
27. Ludington-Hoe, S. M. (2011). Kangaroo care as a neonatal therapy. Neonatal Network, 30(6), 385–393. https://doi.org/10.1891/0730-0832.30.6.385
28. Lupu, M., Herescu, O., Albu, S., Iordache, A. M., Călugăru, D. (2023). The influence of mode of delivery on neonatal outcomes: sleep patterns and stress adaptation. Life, 13(2), 300. https://doi.org/10.3390/life13020300
29. Mindell, J. A., Owens, J. A. (2015). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems (3nd ed.). Lippincott Williams & Wilkins, a Wolters Kluwer business. https://pediatrics. lwwhealthlibrary.com/book.aspx?bookid=3054§ionid=0
30. Moon, R. Y., Carlin, R. F., Hand, I., Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022). Evidence base for 2022 updated recommendations for a safe infant sleeping environment to reduce the risk of sleep-related infant deaths. Pediatrics, 150(1), e2022057991. https://doi.org/ 10.1542/peds.2022-057990
31. Morales-Muñoz, I., Broome, M. R., Marwaha, S. (2020). Association of parent-reported sleep problems in early childhood with mental health problems in adolescence. JAMA Network Open, 3(3), e201138–e201138. https://doi.org/10.1001/jamanetworkopen.2020.1138
32. Morse, A. M., McCall, C. A., He, J., Kim, D., Johnson, N. L., Hall, W. A. (2023). Pediatric sleep tools: An updated literature review. Journal of Pediatric Health Care, 37(3), 290–300. https://doi.org/10.1016/j.pedhc.2022.12.005
33. Namjoo, R., Mehdipour-Rabori, R., Bagherian, B., Nematollahi, M. (2022). Comparing the effectiveness of mother’s live lullaby and recorded lullaby on physiological responses and sleep of preterm infants: a clinical trial study. Journal of Complementary and Integrative Medicine, 19(1), 121-129. https://doi.org/10.1515/jcim-2020-0507
34. Owens, J. A., Spirito, A., McGuinn, M. (2000). The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep, 23(8), 1043–1051. https://doi.org/ 10.1093/ sleep/23.8.1d
35. Özkan, A., Şenol, C. (2022). Ninnilerin anne-bebek ilişkisine etkisi: Sistematik derleme. Hemşirelikte Eğitim ve Araştırma Dergisi, 19(1), 45–52. https://doi.org/ 10.5222/jera.2022.73985
36. Özkan, H., Aslan, D. (2020). Postpartum ebe eğitiminin anne-bebek uyku düzeni üzerindeki etkisi: Randomize kontrollü çalışma. Kadın Sağlığı Hemşireliği Dergisi, 3(1), 12–20.
37. Patel, A. K., Reddy, V., Shumway, K. R., Araujo, J. F. (2024). Physiology, sleep stages. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books /NBK526132/
38. Pathak, B. G., Sinha, B., Sharma, N., Mazumder, S., & Bhandari, N. (2023). Effects of kangaroo mother care on maternal and paternal health: systematic review and meta-analysis. Bulletin of the World Health Organization, 101(6), 391.
39. Pittner, K., Rasmussen, J., Lim, M.M., Gilmore, J.H., Styner, M., Entringer, S., Wadhwa, P.D., Buss, C., 2023, Sleep across the first year of life is prospectively associated with brain volume in 12-months old infants. Neurobiol Sleep Circadian Rhythms, Mar 8;14:100091. https://doi.org/ 10.1016/j.nbscr.2023.100091
40. Rezaei, R., Nia, H. S., Beheshti, Z., Saatsaz, S. (2023). The efficacy of massage as a nightly bedtime routine on infant sleep condition and mother sleep quality: A randomized controlled trial. Journal of Neonatal Nursing, 29(2), 393-398. https://doi.org/10.1016/j.jnn.2022.07.026
41. Sadeh, A. (2004). A brief screening questionnaire for infant sleep problems: validation and findings for an Internet sample. Pediatrics, 113(6), e570–e577. https://doi.org/ 10.1542/peds.113.6.e570
42. Sadeh, A., De Marcas, G., Guri, Y., Berger, A., Tikotzky, L., Bar-Haim, Y. (2015). Infant sleep predicts attention regulation and behavior problems at 3–4 years of age. Developmental Neuropsychology, 40(3), 122–137. https://doi.org/10.1080/87565641.2014.973498
43. Shipton, E. V., Callaway, L., Foxcroft, K., Lee, N., de Jersey, S. J. (2023). Midwife-led continuity of antenatal care and breastfeeding duration beyond postpartum hospital discharge: A systematic review. Journal of Human Lactation, 39(3), 427-440. https://doi.org/ 10.1177/08903344221126644
44. Unno, M., Morisaki, T., Kinoshita, M., Saikusa, M., Iwata, S., Fukaya, S., & Iwata, O. (2022). Validation of actigraphy in hospitalised newborn infants using video-polysomnography. Journal of Sleep Research, 31(1), e13437. https://doi.org/10.1111/jsr.13437
45. Ülgen, Ö., Barış, H. E., Özbörü Aşkan, Ö., Akdere, S. K., Ilgın, C., Özdemir, H., et al. (2023). Sleep assessment in preterm infants: Use of actigraphy and aEEG. Sleep Medicine, 101, 260–268. https://doi.org/10.1016/ j.sleep.2022.11.020
46. Woodward, L. J., Ludwig, R. J., Gong, A., Myers, M. M., Welch, M. G. (2024). Family Nurture Intervention and mother–preterm infant autonomic emotional connection in the neonatal intensive care unit: A review. Acta Paediatrica, 114(4): 760-771. https://doi.org/10.1111/ apa.17456
47. World Health Organization (WHO), & UNICEF. (2009). Ten steps to successful breastfeeding. Baby-Friendly Hospital Initiative. Available from: https://www.who.int/ teams/nutrition-and-food-safety/food-and-nutrition-actions-in-health-systems/ten-steps-to-successful-breastfeeding
48. World Health Organization (WHO). (2006). Postnatal care of the mother and newborn. WHO Press.
49. World Health Organization (WHO). (2013). Postnatal care of the mother and newborn 2013: Guidelines. https://www.who.int/publications/i/item/9789241506649
50. Yılmaz, D., Dağlı, F. Ş. (2023). Bebeklerde uyku düzeni ve ebeveyn davranışları: Müdahale temelli bir eğitim programı. Erken Çocukluk Çalışmaları Dergisi, 7(1), 45–60.https://journalofomepturkey.org/index.php/eccd/ article/download/18/223/1761