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Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of “Quiet Time”

Pugliesi, Raiani Roberta, RN; Campillos, Michelle Siqueira, RN; Calado Orsi, Kelly Cristina Sbampato, MNSc, RN; Avena, Marta José, PhD, RN; Pradella-Hallinan, Marcia Lurdes de Cacia, MD, PhD; Tsunemi, Miriam Harumi, PhD; Avelar, Ariane Ferreira Machado, PhD, RN; Pinheiro, Eliana Moreira, PhD, RN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000549
Original Research

Background: Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day.

Purpose: To determine the impact of quiet time on reducing sound levels and increasing total sleep time.

Methods: This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours.

Results: The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours.

Implications for Practice: Quiet time is a nursing intervention that should be implemented in all neonatal units.

Implications for Research: Future research should use a greater sample size and other factors that influence sleep should be further investigated.

Nursing School, Universidade Federal de São Paulo, São Paulo, Brazil (Mss Pugliesi, Campillos, and Orsi and Drs Avena, Avelar, and Pinheiro); Associação Fundo de Incentivo à Pesquisa, Instituto do Sono, São Paulo, Brazil (Dr Pradella-Hallinan); and Department of Biostatistics, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brazil (Dr Tsunemi).

Correspondence: Kelly Cristina Sbampato Calado Orsi, MNSc, RN, Nursing School, Federal University of São Paulo, Rua Napoleão de Barros, 754 Office 106, Vila Clementino, São Paulo, Brazil, CEP 04024002 (

Fundação de Amparo a Pesquisa do Estado de São Paulo—FAPESP, process number 2012/50365-2.

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses