The Effect of Facilitated Tucking and White Noise on Stress and Sleep of Newborns in Nasal CPAP
Condition: Newborn; Newborn Sleep; Newborn Stress
Study type: Interventional

Summary: 
      Purpose: Newborns go through biochemical and physiological changes involving all their
      systems in the first days of their lives and may experience difficulties in adapting to
      extrauterine life due to various reasons. For newborns whose systems are still immature,
      leaving the warm, dark, quiet, calm, fluid-filled mother's womb and placing them in the
      intensive care unit with many stimuli creates intense stress and negatively affects the
      sleep-wake order necessary for brain development and maturation. Newborns have extensive
      sleep requirements for the development of their neurosensory system. It is known that the
      brain activity of newborns in the intrauterine period is similar to the REM (Rapid Eye
      Movement) sleep activity, and they sleep more than adults and spend most of their sleep in
      the REM sleep period.Therefore, sleep quality in the newborn period is directly related to
      healthy development.In this direction, our research was carried out to examine the effects of
      fetal position and white noise on stress and sleep in newborns with nasal CPAP(Continuous
      Positive Airway Pressure).

      Design and Methods: . This randomized experimental study was conducted on 108 newborns at the
      gestational week of 26 or higher in the newborn intensive care unit of a university hospital.
      The researcher applied white noise (n:36), and facilitated tucking(n:36) to the newborns. The
      control group (n: 36) received no intervention except for the routine clinical practices.
      Facilitated tucking white noise interventions were applied to the newborns included in study
      for 24 hours, their stress levels were monitored with the neonatal stress scale, and their
      sleep durations were monitored with a sleep-wakefulness measurement device and recorded in
      the newborn follow-up form. Statistical analysis was performed using percentages, means, and
      ANOVA test.
    

Detailed description: 
      Sleep is very important for human life and includes both physiological and mental processes
      in development. Sleep is considered not only as a resting state, but also as a state of
      intense brain development in which neurotransmitters specific to each sleep stage affect
      brain maturation. Sleep constitutes a large part of the life of newborns and children.
      However, total daily sleep time, time to fall asleep, daytime sleep and sleep structure may
      differ according to the age of the child. It is known that the brain activity of newborns in
      the intrauterine period is completely similar to the sleep activity of the REM period, and
      they sleep more than adults and spend most of their sleep in the REM sleep period. Therefore,
      sleep quality in the newborn period is directly related to healthy development. Newborns who
      are separated from the warm, dark, quiet, calm, fluid-filled mother's womb, which is the
      natural environment for them after birth, undergo biochemical and physiological changes
      involving all their systems in the first days of their life, and may experience difficulties
      in adapting to extrauterine life due to various reasons. Respiratory problems are among the
      leading causes of mortality and morbidity in the neonatal period. Nasal CPAP and mechanical
      ventilation support are the leading techniques used to provide oxygenation and ventilation in
      the treatment of infants with or without respiratory distress. Nasal CPAP is widely used in
      newborns, especially preterm infants, both as primary therapy and as a respiratory support
      method after extubation. However, complications such as hyperemia in the nose, crust
      formation, bleeding, forehead and face injuries, and infection may develop due to CPAP
      application. In order to prevent possible complications, neonatal intensive care unit (NICU)
      nurses should be trained about these risks and complications, specialist nursing care and
      infection. control protocols should be implemented.Nurses who spend the most time in the
      neonatal intensive care unit are members of the profession responsible for ensuring the
      adaptation of newborns to the external environment, optimal growth and development,
      protection from diseases and maximizing the condition of the newborn, as well as basic
      nursing practices. The neonatal intensive care nurse monitors the clinical signs and symptoms
      of the newborn, evaluates and interprets in line with evidence-based information, and
      determines the care needs with a family-centered approach, makes the nursing diagnosis, plans
      and implements the care, provides training and counseling . When determining the care needs,
      it takes into account the risk status of the newborn, the length of hospitalization, the
      stimuli to which he is exposed, the level of pain and stress, the application of surgical
      intervention and the presence of invasive applications . In order to prevent situations that
      reduce or consume the energy resources required for physiological growth of the newborn, to
      protect the energy resources that are wasted, to accelerate the healing process, to reduce
      pain, stress, autonomic response and oxygen consumption, to provide sleep pattern, comfort
      and immobilization, the neonatal intensive care nurse has and non-pharmacological methods.
      Facilitated tucking white noise are among the non-pharmacological methods frequently used by
      neonatal nurses.The facilitated tucking is a method that allows the baby to feel and calm
      down in the womb, to develop behaviors to cope with pain and stress, to feel safe, and to
      provide body control. In addition, it is a position that improves the sleep pattern that
      supports motor development, growth and development, and creates a synergistic effect in pain
      control. It has been reported that this position provides heat and tactile stimulation in
      newborns, activating the newborns' regulatory systems, preventing painful stimuli from the
      external environment and reducing the pain experienced by the newborns. Studies have also
      shown that the facilitated tucking warmth and tactile stimulation in newborns, activates the
      newborn's own regulatory systems, activates the newborn's attention, prevents painful stimuli
      originating from the external environment, increases the release of endogenous endorphins,
      helps the distribution of pain impulses in the spinal cord, and reduces the pain felt by
      newborn . It has been stated that it is an effective method in reducing the crying time and
      pain after the procedures.

      White noise is a continuous monotonous sound such as the sound of wind, waterfall, ocean
      waves or rain coming from the environment, and it is a sound that is prepared digitally by
      mixing different frequency sounds in equal proportions in the laboratory environment and is
      prepared by calibrating all the frequencies in the sound and it is pleasant to the ear. White
      noise sources include rain, waterfall, water sounds, hair dryer sound, vacuum cleaner sound,
      aspirator sound, clock sound, heart sound. When the literature is examined that white noise
      played during the heel blood collection process in newborns reduces the baby's pain score and
      shortens the crying time. Similarly, preterm newborns were listened to during the white noise
      vaccination process and it was found to have a pain-reducing effect compared to the control
      group.

      White noise is similar to the sound in the womb as it is a humming and continuous monotonous
      sound. It is known that the newborn is affected by the mother's heartbeat while in the womb,
      and finding this sound and rhythm after birth has a relaxing effect on the newborn. In
      experimental studies conducted in the relevant field, it has been observed that newborns
      sleeping in a room where the sound of the uterus is heard fall asleep earlier than those in
      the room where no sound is heard, and this shows that newborns begin to gain a certain
      sensitivity to music before they are born.

      When the literature is examined, it has been stated facilitated tucking white noise may
      affect the sleep quality of newborns. However, it has been observed that there is no study
      examining the difference between facilitated tucking and white noise. In this direction,
      research was carried out to examine the effects of facilitated tucking and white noise on the
      stress and sleep of newborns in Nasal CPAP.
    

Intervention name(s): white noise
Intervention type(s): Other
Intervention description(s): Newborns in the control group did not receive any treatment other than routine applications while receiving nasal CPAP support in the neonatal intensive care unit.The newborns in the faciliated tucking group were given supine, prone, and lateral positions for 24 hours, depending on their clinical status.The newborns in the white noise group were listened to white noise for 24 hours using an Mp3 player and a decibel measuring device to measure the sound level.
Other intervention name(s): facilitated tucking; control
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: newborn; sleep; stress; white noise; facilitated tucking