Patterns of premature Newborns' sleep-wake states before and after nursing interventions on the night shift

Objective: To examine patterns of behavioral states of premature newborns before and after nursing interventions. Design: Secondary analysis of videotaped data, using a repeated measures design. Setting: 18-bed neonatal intensive- and intermediate-care unit in a 400-bed suburban teaching hospital. Participants: Forty medically stable premature newborns with an average postconceptional age of 32.79 weeks at the time of testing. Main outcome measure: Behavioral states measured by observations of videotape recordings. Results: Five-hour observations of behavioral states revealed that newborns showed more quiet sleep, F (2, 38) = 5.65, p = .023, and fewer waking episodes, F (2, 38) = 14.4, p = .001, in the 30 minutes after nursing interventions than in the 30 minutes before. This repeated measures ANOVA analysis accounted for effects of caffeine or theophylline. Neither the frequency nor the duration of nursing interventions predicted duration or frequency of behavioral states before or after interventions. Some newborns experience waking outside the context of nursing interventions. Conclusions: For medically stable newborns, nursing interventions are generally followed by sleep, possibly indicating satiety after feeding or significant energy expenditure. The findings also may suggest that some newborns show anticipation of feeding by waking, although 50% of the newborns did not experience any waking prior to interventions. Further research is needed to examine associations between specific types of nursing interventions and newborn behavioral responses, as well as the relationship of behavioral state patterns and newborn development.