Article

Cycled light in the intensive care unit for preterm and low birth weight infants

Neonatal Unit, Mayanei HaYeshua Medical Centre, Bnei Brak, Israel.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2011; 8(1):CD006982. DOI: 10.1002/14651858.CD006982.pub2
Source: PubMed

ABSTRACT

The pregnant woman is exposed to variable intensities of lighting and sound and, in general, lower levels at night. Some of the lighting and sound reaches the fetus in the womb and induces circadian rhythms. Circadian is a term used to describe biological processes that recur naturally on a 24-hour basis. After birth, preterm infants are cared for in an environment that has no planned light-dark cycles or any other circadian entraining signals. Infants are exposed to either continuous bright light, continuous near darkness or an unstructured combination of the two. Our primary objective was to determine the effectiveness of cycled light (approximately 12 hours of light on and 12 hours of light off) on growth in preterm infants at three and six months of corrected gestational age. To May 2013, 506 infants have been enrolled in trials assessing the effect of cycled light. One study reported improved growth at three months of age in infants exposed to cycled lighting compared with continuous bright light. One study found no difference in weight at four months of age. Only a few outcomes reached statistical significance, which is likely to be due to the small number of infants enrolled in the studies, but trends for most outcomes (weight gain, length of stay, incidence of retinopathy of prematurity, time spent crying) favoured cycled light compared with near darkness and cycled light compared with continuous bright light.

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    • "For example, lighting in individual NICUs varies from continuous bright light through 12 h light/dark cycles to dim lighting. Specific lighting patterns, such as continuous bright light, have been shown to adversely affect outcomes such as weight gain, length of stay, and time spent crying in preterm infants[22]. Similarly, although there are published recommendations regarding a maximum noise level[23], units can rarely keep the noise below these limits[24,25]. "
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    • "Several studies in the last few years have highlighted the fact that postnatal environment, and in particular light, exerts a major long-lasting influence on the individual's circadian system later in life [2]. This may also occur in preterm babies exposed to abnormal light environments in Neonatal Intensive Care Units, as this experience can affect their short-term recovery and growth [3], together with their long-term sleep patterns and neurodevelopment [4], [5]. Therefore, it is critical to determine the mechanisms behind early programming of the circadian system by light, as a first step towards uncovering the consequences of abnormal light exposure during development. "
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    • "Higher physical demands and workloads placed on nurses could negatively affect the level of care provided. Additional key physical characteristics include internal and external noise [50,51], temperature control, exposure to light [52,53], practice of developmentally supportive care [54], provision and extent of family-centered care, provision and extent of breastfeeding support, potential for continuous parental involvement, as well as training and preparation for discharge home. "
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