1MS in Neonatal Intensive Care, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2Instructor of Pediatrics Nursing, Department of Pediatrics Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
3Associate professor of Neonatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4Instructor of Occupational Health Engineering, Department of Occupational Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Background: There are extremely stressful stimuli in NICU environment. Although attempts have already saved neonates in this unit, this can disturb the adaptability of the infants in with environmental stimuli. Aim: To determine the effect of quiet time protocol implementation on physiological characteristics of preterm infants. Methods: In this cross-sectional clinical trial, 120 premature infants were randomly divided into experimental and control groups in Neonatal Intensive Care Unit of Ghaem Hospital, Mashhad in year 1393. The quiet time protocol, including preparing the environment, adjustment of the nursing staff and mothers, was performed in the intervention group between 16:00-18:00 p.m., and the control group received routine programs at 11:00-13:00 hours. Blood pressure, heart rate, and respiratory rate were measured in 15-min intervals during the intervention, and one hour before and after both times, as well as the sound level and light intensity. Data analysis was done by Independent t-test, Mann Whitney, ANOVA with Repeated Measures, and Friedman tests using SPSS version 11.5. Results: Of all infants, 40% were girls and 60 % boys. There was no significant difference between the groups regarding systolic (p<0.44) and diastolic BP (p<0.36). The mean heart rate of the intervention group at the second hour of intervention (135.7±12.4) was significantly lower than the control group (145.7±14.4) (p<0.02). Respiratory rate at the second hour of the intervention was lower in the quiet time group than that in control (p<0.007). Conclusion: The implementation of quiet time protocol can decrease heart rate and respiratory rate through decrease in the environmental stimuli (noise, light and handling), and is recommended for reducing stress in preterm infants.
Liaw J, Yang L, Wang K, Chen C, Chang T, Yin T. Nonnutritive Sucking and Facilitated Tucking Relieve Preterm Infant Pain During Heel-Sick Procedures: A Prospective, Randomized Controlled Crossover Trial. Int J Nurs Stud. 2012; 49(3):300-9.
Martine R, Fanaroff A, Walsh M. Fanaroff and Martin’s Neonatal Perinatal Medicine: Diseases of the Fetus and Infant .2005:147.
Solimani F. Development Outcome of Low- Birth- Weight Premature Infants. Iran J Pediatr. 2007; 17(1):125-35.
Keshavars M, Eskandari N, Jahdi F, Ahaieri H, Hoseini F, Kalani M. The Effect of Holly Quran Recitation on Physiological Responses of Premature Infant. Journal of Semnan University of Medical Sciences. 2010;11(3):169-77. (Persian)
White JL, Labarba RC. The Effects of Tactile and Kinesthetic Stimulation on Neonatal Developmentin the Premature Infant. Dev Psychobiol. 1976; 9(6):569-77.
Kliegman RM, Behrman RE, Jenson HB, Stanton BF, Zitelli BJ, Davis HW. Nelson Textbook of Pediatrics. 18TH ed. New York: Elsevier. 2007:154-9.
Mathai S, Fernandez A, Mondkar J, Kanbur W. Effects of Tactile-Kinesthetic Stimulation Inpreterms: a Controlled Trial. Indian Pediatr. 2001; 38(10):1091-8.
Acolet D, Modi N, Giannakoulopoulos X, Bond C, Weg W, Clow A, et al. Changes in Plasmacortisol and Catecholamine Concentrations Inresponse to Massage in Preterm Infants. Arch Dis Child. 1993; 68(1):29-31.
Sammons WAH, Lewis JM . Premature babies: A different Beginning. St. Louis: Mosby. 1985.
Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal Sleep/Wake Cycles and the Effect of Environmental Noise on Sleep Disruption in the Intensive Care Unit. Respir Crit Care Med. 2001; 163:451–7.
American Academy of Pediatrics. Noise: A Hazard for the Fetus & Newborn. Pediatrics. 1997; 100(4):724-7.
Calabro JA, Wolfe RO, Shoemark HF. The Effect of Recorded Sedative Music on physiology & behavior of Premature Infants with Respiratory Disorders. AJMT. 2003; 14(2003):3-19.
Bremmer P, Byers JF, Kiehl E. Noise and the Premature Infant: Physiological Effects and Practice Implications. Jognn. 2003; 32(4):447–54.
Morris BH, Bose KP. Physiological Effects of Sound on the Newborn. J Perinatol. 2000; 20(2):55-60.
Philbin MK, Klass P. Hearing and Behavioral Responses to Sound in Full-Term Newborns. J Perinatol. 2000; 20(8):68-76.
Philbin K. The Influence of Auditory Experience on the Behavior of Preterm Newborns. J Perinatol. 2000; 20(8):77-87.
Mirmiran M. Circadian and Sleep Development in Preterm Infants Occurs Independently From the of Environmental Lighting. Pediatr Res. 2003; 53(6):933-8.
Glotzbuch SF, Edgar DM, Ariagno RL. Biological Rhythmicity in Preterm Infants Prior to Discharge From Neonatal Intansive Care. Pediatr. 1995; 95(2):231-7.
Boo NY, Chee SC, Rohana J. Randomized Controlled Study of the Effects of Different Durations of Light Exposure on Weight Gain by Preterm Infants in a Neonatal Intensive Care Unit. Acta Paediatr. 2009; 91(6):674-9.
Blackburn S, Patterson D. Efforts of Cycled Light on Activity State and Cardiorespiratory Function in Preterm Infants. J Perinat Neonatal Nurs. 1991;4(4):47-54.
Shoghy MH, Sanjari MH. Lifer Textbook of Nursing Mothers and Neonatae. 10th ed. Tehran: Pub Boshra. 2008.
Mohammdzde A. Stress of NICU on the Neonatal Health. Neonatal Research Center. Mashhad University of Medical Sciences. (Persian)
Calabro JA, Wolfe RO, Shoemark HF. The Effect of Recorded Sedative Music on physiology & behavior of Permatuer Infants with Respiratory Disoeders. AJMT. 2013; 131(5):902-18.
Wong D.Wong, s Essentials of Pediatric Nuesing. 6TH ed. 2001.
Kadivar M. Challanges Sterses and Injuries due Hospitalized Infant in the Neonatal Intensive Care Unit. Pediatrics Diseases in Iran. 2000; 13(3). (Persian)
Hunt, Kristin N. The NICU: Environmental Effects of the Neonatal Intensive Care Unit on Infants and Caregivers. Reaserch Papers. 2011:71.
Sandgol V, Ryhani T, Boskabadi H,Esmaili H. Effect of Creating as Artifical Night on Physiological Changes,Weight and Feeding Tolerance in Preterm Infants. M.S thesis. Mashhad University of Medical Sciences. 2011. (Persian)
Kadivar M, Noorbakhsh SH. Kangaroo Care. Nashre Vista; 1387:12-3.
Boehm H, Morast S. Quiet Time: A Daily Period without Distractions Benefits Both Patients and Nurses. AJN. 2009; 109)11(:29-32.
Quite Time on the Neonatal Intensive Care Unit. August 3rd 2009 (version 1-NICU123).
Cranmer K, Davenport L. Quiet Time in a Pediatric Medical/Surgical Setting. J Pediatr Nur. 2013; 28(4):400-5.
Slevin M, Farrington N, Duffy G, Daly L and Murphy JFA. Altering the NICU and Measuring Infants' Responses. Acta Pediatr. 2000; 8(9):577-81.
Abujarir R, Salama H, Greer W, Alhani M, Visda F. The Imapact of Earmuffs on Vital Signs in a Neonatal Intensive Care Unit. Neonatalogy Today. 2012; 2(7)1-11.
Shiroiwa Y, Kamiya Y, Uchibori S, Inukai K, Kito H, Shibata T, Ogawa J. Activity, Cardiac and Respiratory Responses of Blindfold Preterm Infants in a Neonatal Intensive Care Unit. Eury Human Development. 1986; 14(3-4):259-65.
Ramesh A, Suman Rao PN, Sandeep G, Nagapoornima M, Srilakshmi V, Dominic M. Efficacy of a Low Cost Protocol in Reducing Noise Levels in the Neonatal Intensive Care Unit. Indian J Pediatr. 2009; 76(5):475-8.
Christina Dennis CM, Lee R, Woodard EK, Szalaj JJ, Walker CA. Benefits of Quiet Time for Neuro-Intensive Care Patients. J Neurosci Nurs. 2010; 42(4):217-24