The Effects of Environmentally Induced Influences on the Neurologial Maturation and Weight Gain of Premature Infants
Premature birth deprives the infant of the influences of maternal uterine stimulation on his physical growth and neurological development. It also deprives the newborn of the influences of the maternal sleep cycle and other aspects of maternal cyclicity. This problem has been recognized and studied for at least two decades by physiologists and neonatologists, but very few studies have been done on manipulating the premature infant's environment in order to foster cyclic patterns such as sleep. It had been observed by this investigator that premature infants in a neonatal intensive care unit are often disturbed from quiet sleep so that the nurse may administer the required care. The purpose of this study was to determine the effect of increased quiet sleep time in the premature infant on his neurological maturation and weight gain. Quiet sleep time in this study was Increased in the infants in the experimental group by planning nursing care around their quiet sleep time. The problem which was investigated was whether infants who received experimental care to promote quiet sleep would have a significant increase in neurological maturation and weight gain when compared to the control group. Stated as a directional hypothesis, the experimental group would have a significantly larger (p=0.05) increase in neurological maturation and weight gain than the control group. This study used the experimental method of research. The independent variable, patterning of nursing care around the infant's quiet sleep in order to promote quiet sleep, was performed on half of the patients studied. The sample was a purposive convenience sample of 22 patients. All infants were between the gestational and conceptual ages of 31-36 weeks and were considered to be "stable" infants. Neurological examinations, consisting of segments of the Brazelton and the Amiel- Tison examinations, and weight measurements were performed on all sub jects on the day of entry into the study and on the day of dismissal from the study. Infants were studied one, two, or three weeks, depending on time of discharge. Covariates that also were examined were: a history of septicemia, age of entry into the study, and initial weight of the infants. Chi-square and t-tests were used along with measures of central tendency, such as the mean and standard deviation, to analyze the data. The result of the neurological examination segment analysis was that there was no statistical significance (p®0.05) in the neurological maturation of the experimental infants when compared to the control infants. However, there were trends (p=0.10) in some segments of the examination and there was an overall trend of increased neurological maturation in the experimental group. Weight demonstrated no significant (p=0.05) change between the two groups, although the weight gain of the experimental group was slightly larger than that of the control group. In regards to the covariates, there was no statistical difference (p=0.05) between the two groups in the incidence of septicemia, conceptual age of the infant at time of entry into the study, and the initial weight. Based on the data analysis, the directional hypothesis must be rejected. However, it is important to note that statistical trends (p=0.10) were evident in some segments of the neurological examination and that other segments as well as the weight gain demonstrated trends in the direction of the hypothesis.
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