| Objective:(1)To synthesis the evidence of the effectiveness of non-pharmacological interventions on preterm infants' sleep in the neonatal intensive care unit(NICU)and find out the evidence for the clinical trial.(2)To investigate the effects of mother voice and white noise on the growth and development,heart rate,oxygen saturation,sleep and salivary cortisol level in the NICU preterm infants.Methods:(1)Seven electronic databases were searched including MEDLINE,EMBASE,CENTRAL,Wan-fang database,China National Knowledge Infrastructure(CNKI database),China Biological Medicine Database(CBM-disc),and VIP Journal Integration Platform(VJIP)from their inception to August 2017.Randomized controlled trials examining the effect of non-pharmacological interventions on preterm infants' sleep were included.The RevMan5.3 software was used to meta-analysis.(2)A total of 103 preterm infants were enrolled and randomly assigned to three groups.One was the mother humming group(n=35),one was the white noise group(n=34),the other one was the routine care group(n=34).Weight gain,heart rate,oxygen saturation,sleep and the salivary cortisol level were recorded during the interventions.Results:(1)Thirty-six studies were included in the systematic review.Non-pharmacological interventions included the Newborn Individualized Developmental Care and Assessment Program(NIDCAP),music intervention,non-nutritive sucking(NNS),touch,cycled light,co-bedding,rocking,oral sucrose,remolding mattresses and family nurture interventions.The results of Meta-analysiswere as following : a)The NIDCAP had no significant effect on total sleep time efficiency(TST%)(WMD=6.80,95%CI:-7.26~20.86,p=0.34);b)the mattresses interventions had significant effects on TST%(WMD=14.01,95%CI: 8.05-19.98,p<0.001)and active sleep efficiency(AS%)(WMD=9.51,95%CI: 2.75-16.27,p=0.006);c)the co-bedding had no significant effects on QS% and AS%(WMD=2.78,95%CI:-8.65-14.22,p=0.63;WMD=0.28,95%CI:-3.36-3.92,p=0.88,respectively);d)the cycled light increased TST(WMD=1.19,95%CI:0.16~2.22,p=0.02).(2)Clinical trial results(a)The lost rate was 11.6%,twelve premature infants withdrawn from the study mid-way,in which three withdrawn from the mother humming group,four withdrawn from the white noise group and five withdrawn from the blank control group.(b)No significant difference was found in the number of nighttime interference among the three groups.(c)There was no significant difference on the salivary cortisol levels among the three groups,and the salivary cortisol levels in each group had no significant change between the before intervention and after intervention.(d)The weight of preterm infants in each group increased significantly between the before intervention and after intervention(p<0.05).The weight gain of preterm infants in the white noise group was significantly higher 46.7g than the mother humming group(p=0.019),and compared to the control group average increased34.5g(p=0.083).(e)There were no significant changes in heart rate and oxygen saturation in preterm infants between the three groups.However,the heart rate was lower during the intervention than the pre-intervention(p=0.003),and oxygen saturation in the middle-intervention was found higher than the pre-intervention and after-intervention(p<0.05).(f)The sleep efficiency and sleep time between the three groups showed no significant difference.Using the subjective observation method,preterm infants showed more sleep efficiency and sleep time in the pre-intervention than the after-intervention in each group(p<0.05);while,using the actigraphy monitor,onlythe blank control group showed higher sleep efficiency and sleep time in the pre-intervention than the after-intervention(p<0.05);and the sleep efficiency and sleep time of the subjective observation method were significantly higher than the actigraphy monitored(p<0.05).(g)There was no significant difference between the three groups in sleep latency,wake after sleep onset(WASO),avg-awakening(p>0.05),but the number of awakenings in the white noise group was 4.8 times higher than the mother humming group(p=0.046).Besides the WASO and avg-awakening were significantly lower in the pre-intervention than the after-intervention(p=0.019)in the blank control group.(h)The sleep behavior scores between the three groups and the intervention process were both non-significant(p>0.05).However,the generalized estimating equation(GEE)shows that,between the three groups,the state of active awake was significantly lower on the white noise group than the controlled group and the mother humming group(p=0.034,p=0.032);only the quiet sleep state in the after-intervention was lower than the pre-intervention and the middle-intervention(p<0.05).During the four-day interventions,the quiet sleep state was significantly lower on the third and fourth day than the first day(p<0.05),and the transitional sleep state was higher on the fourth day than on the first day,the second day and the third day(p<0.05),and the state of quiet awake was lower on the third day than on the first day and the fourth day(p<0.05),and the state of active awake increased with the interventional days(p<0.05),and the state of crying was higher on the second day,the fourth day than on the first day(p <0.05).Conclusions:(1)The types of non-pharmacological interventions were diverse.According to the meta-analysis,the remolding mattress and the cycled light had significant effects on sleep promotion in preterm infants,but the quality of the evidence was low,so high quality studies are waiting to be done.(2)During the evening(19:00 to 07:00),the preterm infants were disturbed in every 1.2 hours.the mother humming music and the white noise had no positive effects or negative effects on the preterm infants' cortisol secretion,heart rate,oxygen saturation,sleep efficiency,sleep time,sleep latency,wake after sleep onset(WASO),avg-awakening;while,the mother humming music might reduce the number of awakenings than the white noise group.During the intervention,the white noise reduced the active awake state comparing to the mother humming group and the blanke group,while,the other sleep states did not show any significant effects between groups.The quiet sleep state was less on the after-intervention than the pre-intervention and the middle-intervention;the quiet sleep state was decreased with intervention days,while the active awake state was increased with intervention days.In addition,the white noise group may be more beneficial to weight gain in the NICU preterm infants. |
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