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Sleep-Wake Cycling in a Neonate Admitted to the NICU: A Video-EEG Case Study During Hypothermia Treatment

Axelin, Anna RN, PhD; Cilio, Maria Roberta PhD, MD; Asunis, Marilisa MD; Peloquin, Susan RN, MS, CNIV; Franck, Linda S. RN, PhD, FRCPCH, FAAN

The Journal of Perinatal & Neonatal Nursing: July/September 2013 - Volume 27 - Issue 3 - p 263–273
doi: 10.1097/JPN.0b013e31829dc2d3

This retrospective case study describes the sleep-wake cycles of an infant in the neonatal intensive care unit. We analyzed video-electroencephalographic recording of the term infant monitored during treatment with therapeutic hypothermia for hypoxic-ischemic encephalopathy. The continuous video-electroencephalographic recording over a 4-day period also allowed us to describe the following dimensions of daily care in relation to the infant's sleep-wake states: (1) handling by professional and parent caregivers and (2) stress, pain, and analgesia. Physical contact constituted 17% to 36% of each 24-hour period. The infant's care was fragmented, with a mean of 3 to 4 physical contacts per hour. As a result, the structure of infant sleep was altered by the increased amount of awake and quiet sleep. The number of painful procedures ranged from 5 to 24 per day. Nurses were the main care providers. Parents had more contact after the infant was rewarmed. This case study suggests that neonatal intensive care unit infants are exposed to frequent handling and stress as well as altered sleep. The cumulative negative impact of frequent handling and sleep fragmentation may go unnoticed by caregivers focused on episodes of care. Continuous video-electroencephalographic monitoring is a useful tool for longitudinal evaluation of infant sleep and responses to caregiving in the neonatal intensive care unit.

Department of Family Health Care Nursing, University of California, San Francisco (Dr Axelin); and Department of Nursing Science, University of Turku, Turku, Finland (Dr Axelin); Division of Epilepsy and Clinical Neurophysiology, Benioff Children's Hospital, University of California, San Francisco (Drs Cilio and Asunis); NICN, Intensive Care Nursery, UCSF Benioff, Children's Hospital, University of California, San Francisco (Ms Peloquin); and Department of Family Health Care Nursing, University of California, San Francisco (Dr Franck).

Corresponding Author: Anna Axelin, PhD, RN, Department of Nursing Science, 20014 University of Turku, Finland (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: March 18, 2013; accepted for publication: May 27, 2013.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins.