Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of "Quiet Time".

BACKGROUND: Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day. PURPOSE: To determine the impact of quiet time on reducing sound levels and increasing total sleep time. METHODS: This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours. RESULTS: The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours. IMPLICATIONS FOR PRACTICE: Quiet time is a nursing intervention that should be implemented in all neonatal units. IMPLICATIONS FOR RESEARCH: Future research should use a greater sample size and other factors that influence sleep should be further investigated.

[Effect of reducing sensory and environmental stimuli during hospitalized premature infant sleep]. / Efeito da redução de estímulos sensoriais e ambientais no sono de recém-nascidos pré-termo hospitalizados.

OBJECTIVE: To compare the total sleep time of premature infant in the presence or absence of reducing sensory and environmental stimuli in the neonatal unit. METHOD: Longitudinal study in a Neonatal Intermediate Care Unit of a public hospital in Sao Paulo. The sample consisted of 13 premature infants. We used polysomnograph and unstructured observation for data collection. We analyzed 240 and 1200 minutes corresponding to the periods of the presence and absence of environmental management, respectively. Data were compared in proportion to the total sleep time in the two moments proposed by the study. RESULTS: The total sleep time in periods without environmental management was on average 696.4 (± 112.1) minutes and with management 168.5 (± 27.9) minutes, proportionally premature infant slept an average of 70.2% during periods with no intervention and 58.0% without management (p=0.002). CONCLUSION: Reducing stimulation and handling of premature infant environment periods was effective to provide greater total sleep time.

[Workers' knowledge and perception regarding noise in the neonatal unit]. / Conhecimento e percepção dos profissionais a respeito do ruído na unidade neonatal.

The objective of the study was to assess the knowledge and perception of professionals working in a Neonatal Intensive Care Unit (NICU) regarding the repercussions of noise on the neonates, families and workers, prior to the implementation of an educational program. This qualitative descriptive study was conducted in a NICU of a São Paulo hospital with 101 professionals. A questionnaire was used for data collection, and chi-square and Student's t test were used to determine the association between variables. The workers described the NICU as very noisy (44.9%); they noticed the effects of noise during and after their work shift (67.4%) and used strategies to reduce noise. Despite not being familiar with legislation regarding noise in the hospital, the workers identify its repercussions on themselves, the neonates and families. Results indicate the need to teach the staff about legislation and noise prevention, as well as reorganize healthcare practices and Neonatal Intensive Care Unit facilities.

[Sound pressure levels in the neonatal intensive care unit]. / Nível de pressão sonora em Unidade de Terapia Intensiva Neonatal.

The objectives of the study were to assess sound pressure level (SPL) in two rooms of a Neonatal Intensive Care Unit (NICU) and to identify their sources. This quantitative-descriptive study was conducted in two rooms of a NICU of a University Hospital in São Paulo, Brazil. Three dosimeters were used to register SPL (total of 261 hours). A 48-hour register of noise sources was obtained. The results showed high SPL in both rooms. The greatest mean Leq were 71.0 dBA (room A) and 68.0 dBA (room B). Main noise sources in both units were: NICU hallway noise, traffic and conversation among professionals. The results indicate that SPLs in NICU rooms are higher than the levels recommended by regulatory agencies. A guideline was developed and an educational program was implemented as a means to reduce sound pressure levels.

Quasi-Experimental study of effects of lighting on rest, activity and melatonin in postpartum women.

OBJECTIVES: to compare the parameters of the activity/rest cycle of early postpartum breastfeeding women under a controlled and uncontrolled long wavelength ray light regimen. METHODS: quasi-experimental study with breastfeeding women and their babies during postnatal rooming-in, São Paulo, Brazil. Participants were allocated to either an experimental (intervention) or a comparison group. The intervention involved exposure of the woman in a controlled room with artificial long wavelength ray light at night. Each woman's level of 6-sulfatoxymelatonin at 24 hours and activity/rest times was analyzed. RESULTS: the mean activity/rest times of women in the experimental and comparison groups were similar. The mean percentages of total load of 6-sulfatoxymelatonin during the day and night were similar (p=0.09). At 24 hours, the experimental group presented a significantly lower mean percentage of total load compared to the comparison group (p=0.04). CONCLUSIONS: women who stayed in the room with long-wavelength artificial light showed no difference in activity/rest and 6-sulfatoxymelatonin levels in the early postpartum period.

Risk and protective factors for sudden infant death syndrome.

OBJECTIVES: To verify the occurrence of the risk and protective factors for sudden infant death syndrome during nursing consultation. METHODS: Retrospective cohort study conducted based on medical records from a primary care unit in the municipality of São Paulo. The sample consisted of 63 infants assisted from January to December 2016. RESULTS: The average age of infants was 3.2 months. The main risk factors identified were the presence of soft objects in the crib (93.6%) and bed sharing (58.7%). Predominant protective factors were breastfeeding (95.2%) followed by updated immunization (90.5%). CONCLUSIONS: Risk and protective factors for sudden infant death syndrome were identified in the study sample, indicating the importance of addressing the issue with families of children under 1 year of age to prevent the occurrence of such events.

Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study.

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the "quiet" times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors (p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

[Perceptions of newborns' families about the communication of bad news]. / Percepções da família do recém-nascido hospitalizado sobre a comunicação de más notícias.

The present study aims to describe how families perceive the communication of bad news about hospitalized newborns given by professionals. A qualitative and descriptive study was carried out with families of hospitalized newborns in the neonatal unit. Five mothers and one father were interviewed The thematic analysis of data revealed four categories: Message content in relation to clarity, detailing and not disclosed information. The way the news was transmitted: leads to ambiguity in reactions. Families' perceptions aboutprofessionals' attitudes to transmit the news: sometimes attitudes are different depending on the professional's experience and involvement with the customer. Use of communication strategies for message transmission: considered by the families as a mean to minimize the gravity of the baby's problem. The results pointed out the use of a non symmetrical communication between professional-family The adoption of a team practice, which incorporates it in its interventions, may meet the families' needs of information and social support.

The meaning of interaction between nursing professionals and newborns/families in a hospital setting.

This study aimed to understand the meaning of the nursing team's communication with newborns and families during care delivered in a neonatal unit and also to develop a theoretical model. Symbolic Interactionism and Hargie's model were used as theoretical and Grounded theory as the methodological reference framework. The study was carried out at the nursery of a hospital in São Paulo, SP, Brazil. The study sample was composed of three nurses and four nursing auxiliaries. The theoretical model Being mediated by the strength of motivation was based on findings and revealed the role the nursing professionals' motivation played during interactions with newborns and families. The conclusion is that more humanized interactions with newborns and families result from the nursing professionals' motivation.

Sleep and salivary cortisol in preterm neonates: a clinical, randomized, controlled, crossover study.

OBJECTIVE: Analyze the influence of ear protectors on the baseline levels of salivary cortisol and response and total sleep time of preterm neonates during two periods of environmental management of a neonatal intermediate care unit. METHOD: A clinical, randomized, controlled and crossover study conducted with 12 preterm neonates. The use of ear protectors was randomized in two periods. Sleep evaluation was performed using one Alice 5 Polysomnography System and unstructured observation. RESULTS: No significant difference was observed between the baseline levels of salivary cortisol and response in preterm neonates from the control and experimental groups, and no statistical significance was observed between the total sleep time of both groups. No relationship was observed between the baseline levels of cortisol and response and total sleep time. CONCLUSION: Ear protectors in preterm neonates did not influence the salivary cortisol level and total sleep time in the studied periods.

Nível de iluminação em Unidades Neonatais, segundo manejo do ambiente e mobiliário / Nivel de iluminación en unidades neonatales, según el manejo del ambiente y del mobiliario / Lighting level in Neonatal Units according to environment and furniture management

Resumo Objetivo Identificar os níveis de iluminação em unidades de terapia intensiva neonatais que realizam ou não períodos de manejo ambiental, segundo tipos de mobiliários, e indicar qual a condição que promove melhor ambiente ao recém-nascido, com relação à iluminação. Métodos Estudo transversal, descritivo e de correlação. A amostra foi composta pela mensuração da iluminância dentro de incubadora, incubadora com fotoproteção e berço de acrílico, posicionados segundo a proximidade da luz natural. As medições com luxímetro ocorreram a cada 60 segundos durante 24 horas ininterruptas por posição, em duas unidades de terapia intensiva neonatal iluminadas por luz natural e luz artificial incandescente, uma que não realiza o manejo ambiental (Instituição A) e outra que realiza por períodos de uma hora, quatro vezes ao dia (Instituição B). Para a análise dos dados foram utilizados os testes de Mann Whitney, Friedman e de Nemenyi. Resultados Os níveis de iluminação apresentaram grande variação conforme o período do dia e o tipo de mobiliário (mín=0;máx=889 lux), sendo superiores nos berços de acrílico. As posições distantes da fonte de luz natural não proporcionaram menores níveis de luz. A fotoproteção sobre as incubadoras propiciou menor exposição à luz. Os valores médios de iluminância em todas as posições consideradas na instituição A foram significativamente maiores, quando comparados à instituição B, demonstrando a eficácia da prática do manejo do ambiente (p<0,05). Conclusão A combinação do uso da proteção escura sobre a incubadora e do manejo do ambiente proporciona a melhor condição de iluminação para os recém-nascidos em unidades neonatais.

Resumen Objetivo Identificar los niveles de iluminación en unidades de terapia intensiva neonatales que realizan o no realizan períodos de manejo ambiental, según el tipo de mobiliario, e indicar qué condición promueve mejor ambiente al recién nacido, con relación a la iluminación. Métodos Estudio transversal, descriptivo y de correlación. La muestra estuvo compuesta por la medida de la iluminancia dentro de la incubadora, incubadora con foto protección y cuna de acrílico, posicionados según la proximidad de la luz natural. Las mediciones con luxómetro se realizaron cada 60 segundos durante 24 horas ininterrumpidas por posición, en dos unidades de cuidados intensivos neonatales iluminadas por luz natural y luz artificial incandescente, una que no realiza el manejo ambiental (institución A) y otra que la realiza por períodos de una hora, cuatro veces al día (institución B). Para el análisis de los datos fueron utilizados las pruebas de Mann Whitney, Friedman y de Nemenyi. Resultados Los niveles de iluminación presentaron gran variación conforme el período del día y el tipo de mobiliario (mín=0; máx=889 lux), superiores en las cunas de acrílico. La posición distante de la fuente de luz natural no proporcionó menores niveles de luz. La foto protección sobre las incubadoras propició una menor exposición a la luz. Los valores promedio de iluminancia en todas las posiciones consideradas en la institución A fueron significativamente más altos al compararlos con los de la institución B, lo que demuestra la eficacia de la práctica del manejo del ambiente (p<0,05). Conclusión La combinación del uso de la protección oscura sobre la incubadora y el manejo del ambiente proporciona una mejor condición de iluminación para los recién nacidos en unidades neonatales.

Abstract Objective To identify the lighting levels in neonatal intensive care units that perform environment management or not according to types of furniture, and indicate which condition promotes the best environment for the newborn in terms of lighting. Methods Cross-sectional, descriptive, correlational study. The sample was composed by measuring the illuminance inside an incubator, an incubator with protection from light and an acrylic crib positioned according to proximity of natural light. Measurements with a luxmeter took place every 60 seconds for 24 uninterrupted hours per position in two neonatal intensive care units lit by natural light and artificial incandescent light, one where environment management is not performed (Institution A) and the other where environment management is performed for one-hour periods, four times a day (Institution B). The Mann Whitney, Friedman and Nemenyi tests were used for data analysis. Results The lighting levels showed great variation according to the period of the day and type of furniture (min=0; max=889 lux), and were higher in acrylic cribs. Positions far from the natural light source did not provide lower light levels. Protection over the incubators provided less exposure to light. The mean illuminance values in all positions considered in institution A were significantly higher compared to institution B, demonstrating the effectiveness of the environment management practice (p<0.05). Conclusion The combination of the use of dark protection over the incubator and environment management practices provides the best lighting condition for newborns in neonatal units.

Effects of Handling and Environment on Preterm Newborns Sleeping in Incubators.

OBJECTIVE: To describe the total sleep time, stages of sleep, and wakefulness of preterm newborns and correlate them to levels of sound pressure, light, temperature, relative air humidity, and handling inside incubators. DESIGN: Observational, correlational study. SETTING: A neonatal intermediate care unit. PARTICIPANTS: Twelve preterm newborns, who were 32.2 ± 4.2 weeks gestational age and weighed 1,606 ± 317 g. METHODS: Sleep records were assessed by polysomnograph. Environmental variables were measured with a noise dosimeter, light meter, and thermohygrometer. To record time and frequency of handling, a video camera was used. All recordings were made for an uninterrupted 24-hour period. RESULTS: Mean total sleep time in 24 hours was 899 ± 71.8 minutes (daytime = 446 ± 45.3 and nighttime = 448 ± 60.2). Mean wakefulness was 552 ± 94.0 minutes. The predominant stage was quiet sleep. A significant correlation was identified only between the levels of light and wakefulness (r = 0.65 and p = .041). CONCLUSION: The environmental conditions and care provided to hospitalized preterm newborns did not influence sleep except for high light levels, which increased wakefulness. Nurses in clinical practice should implement strategies to promote and protect sleep by decreasing newborns' exposure to excessive light.

Elaboração e validação da cartilha "Higiene do Sono para Crianças" / Elaboración y validación de la cartilla "Higiene del sueño para niños" / Development and validation of the "Sleep Hygiene for Children" booklet

Resumo Objetivo Elaborar e validar cartilha sobre higiene do sono para crianças escolares. Métodos Estudo de abordagem metodológica, realizado no período de setembro de 2018 a outubro de 2019, seguindo as etapas de levantamento bibliográfico, elaboração e validação de conteúdo da cartilha por especialistas. O instrumento para validação, encaminhado a três profissionais da área da saúde, foi composto por sete itens, divididos em subitens, com respostas dispostas em escala tipo Likert. Os dados obtidos foram tabulados em planilha do Excel. Considerou-se adequado os valores da proporção de concordância dos subitens entre os examinadores (índice de validade do conteúdo) acima de 80%. Resultados A cartilha foi validada após a segunda rodada de avaliação, atingindo índice de validade de 85,7% do conteúdo total e sendo composta por quatro temas: "O que é higiene do sono?", "Importância do sono", "Como realizar a higiene do sono?" e "Guia rápido de recomendações de higiene do sono". Conclusão A cartilha de higiene do sono para crianças, validada por especialistas na segunda rodada, poderá auxiliar a criança a entender a importância do sono para seu desenvolvimento e obter hábitos adequados de sono e de autocuidado.

Resumen Objetivo Elaborar y validar una cartilla sobre higiene del sueño para niños escolares. Métodos Estudio de enfoque metodológico, realizado en el período de septiembre de 2018 a octubre de 2019, que siguió las etapas de recopilación bibliográfica, elaboración y validación del contenido de la cartilla por especialistas. El instrumento para la validación, que fue enviado a tres profesionales del área de la salud, estaba compuesto por siete ítems, divididos en subítems, con respuestas dispuestas en escala tipo Likert. Los datos obtenidos fueron tabulados en planilla de Excel. Los valores de la proporción de concordancia de los subítems entre los examinadores (índice de validez de contenido) superiores a 80 % se consideraron adecuados. Resultados La cartilla fue validada después de la segunda ronda de evaluación, con un índice de validez del contenido total del 85,7 %. El material está compuesto por cuatro temas: "¿Qué es la higiene del sueño?", "Importancia del sueño", "¿Cómo realizar la higiene del sueño?" y "Guía rápida de recomendaciones de higiene del sueño". Conclusión La cartilla de higiene del sueño para niños, validada por especialistas en la segunda ronda, podrá ayudar a los niños a entender la importancia del sueño para el desarrollo y a obtener hábitos adecuados de sueño y de autocuidado.

Abstract Objective To develop and validate a booklet on sleep hygiene for school children. Methods Methodological study conducted from September 2018 to October 2019, following the steps of bibliographic survey, development and content validation of the booklet by experts. The instrument for validation, sent to three health professionals, was composed of seven items, divided into sub-items with responses arranged on a Likert-type scale. Data obtained were tabulated in an Excel spreadsheet. Values of the proportion of agreement of sub-items between experts (content validity index) above 80% were considered appropriate. Results The booklet was validated after the second evaluation round, reaching a validity rate of 85.7% of the total content. It comprised the following four themes: "What is sleep hygiene?", "Importance of sleep", "How to practice sleep hygiene?" and "Sleep hygiene recommendations quick guide". Conclusion The sleep hygiene booklet for children, validated by experts in the second round, can help children understand the importance of sleep for their development and obtain appropriate sleep and self-care habits.

Effect of sleeping position on arousals from sleep in preterm infants.

PURPOSE: To evaluate the frequency of preterm infant positions during sleep, and to investigate the association among positions, arousals, sleep patterns, and time of day. DESIGN AND METHODS: This observational study was conducted in a neonatal unit with 10 preterm infants. Polysomnographic and video recordings during 24 hr identified sleep positions, arousals, sleep patterns, and time of day. RESULTS: Preterm infants were placed most frequently in the supine position (58.4%), followed by right side (24.9%), left side (15.5%), and prone (1.2%). The longest amount of time spent sleeping, and the most frequent number of arousals, occurred in the supine position, followed by prone, left-side, and right-side positions. After controlling for length of time spent in each position, the number of arousals per hour was the greatest in the supine position (13.562 ± 0.732) and least in the prone position (11.56 ± 4.754; p < .001). There were no significant differences in arousals according to position and sleep pattern (indeterminate, quiet, active sleep) or position and time of day (morning, afternoon, twilight, night). PRACTICE IMPLICATIONS: Nurses should evaluate the frequency of preterm infant arousals in each position, and use more often those positions that lead to a lower frequency of arousals and better sleep quality.

Quasi-Experimental study of effects of lighting on rest, activity and melatonin in postpartum women / Estudo Quasi-Experimental dos efeitos da iluminação no repouso, atividade e melatonina em puérperas / Estudio cuasiexperimental de los efectos de la iluminación em reposo, actividad y melatonina em mujeres posparto

ABSTRACT Objectives: to compare the parameters of the activity/rest cycle of early postpartum breastfeeding women under a controlled and uncontrolled long wavelength ray light regimen. Methods: quasi-experimental study with breastfeeding women and their babies during postnatal rooming-in, São Paulo, Brazil. Participants were allocated to either an experimental (intervention) or a comparison group. The intervention involved exposure of the woman in a controlled room with artificial long wavelength ray light at night. Each woman's level of 6-sulfatoxymelatonin at 24 hours and activity/rest times was analyzed. Results: the mean activity/rest times of women in the experimental and comparison groups were similar. The mean percentages of total load of 6-sulfatoxymelatonin during the day and night were similar (p=0.09). At 24 hours, the experimental group presented a significantly lower mean percentage of total load compared to the comparison group (p=0.04). Conclusions: women who stayed in the room with long-wavelength artificial light showed no difference in activity/rest and 6-sulfatoxymelatonin levels in the early postpartum period.

RESUMO Objetivos: comparar os parâmetros do ciclo de atividade/descanso de puérperas lactantes no início do pós-parto sob regime de iluminação com raios de comprimento de onda longo controlado e descontrolado. Métodos: estudo quase-experimental com lactantes e seus bebês em alojamento conjunto, São Paulo, Brasil. Os participantes foram alocados para grupos experimental (intervenção) ou de comparação. A intervenção consistia na exposição em uma sala controlada com iluminação artificial de raios de comprimento de onda longo à noite. Foram analisados os horários de atividade/repouso (horas) e nível de 6-sulfatoximelatonina em 24 horas. Resultados: a atividade média e os tempos de repouso das mulheres nos grupos experimental e comparação foram semelhantes. Os percentuais médios de volume total de 6-sulfatoximelatonina durante o dia e a noite foram semelhantes (p=0,09). Em 24 horas, o grupo experimental apresentou percentual médio significantemente menor de volume total em relação ao grupo comparação (p=0,04). Conclusões: as mulheres que permaneceram no quarto com luz artificial de comprimento de onda longa não apresentaram diferenças nos níveis de atividade/repouso e 6-sulfatoximelatonina no início do período pós-parto.

RESUMEN Objetivos: comparar parámetros del ciclo actividad/descanso en madres lactantes en posparto temprano bajo régimen lumínico de rayos de longitud de onda larga controlado y no controlado. Métodos: estudio cuasiexperimental con madres lactantes y sus bebés, São Paulo, Brasil. Las participantes fueron asignadas a grupos experimental (intervención) y comparación, consistente en exposición en habitación controlada con luz artificial de rayos de longitud de onda larga durante la noche. Se analizaron tiempos de actividad/descanso (horas) y nivel de 6-sulfatoximelatonina a las 24 horas. Resultados: actividad media y tiempos de descanso fueron similares en grupos comparación e intervención. Porcentajes promedio de volumen total de 6-sulfatoximelatonina durante día y noche resultaron similares (p=0,09). A las 24 horas, el grupo intervención presentó porcentaje promedio de volumen total significantemente menor comparado con grupo comparación (p=0,04). Conclusiones: las mujeres expuestas a luz artificial de longitud de onda larga no mostraron diferencias en niveles actividad/descanso y 6-sulfatoximelatonina durante el posparto temprano.

[The use of videotaping in qualitative research]. / O uso de filmagem em pesquisas qualitativas.

Considering advancements in data collection methods, we explore the use of videotaping in qualitative research. This bibliographical study aims at developing reflections on the possibilities of using videotapes in research and at providing material to researchers. The video is used as an instrument of data collection and generation. We mention technical aspects, such as the utilization of a mobile or fixed camera. By means of the latter, the authors report their experience, emphasizing compliance with the neutrality principle and the possibility of editing the images obtained as a means of generating new data. The authors highlight that it was possible to detect contradictions between discourse and behavior through the use of videotaping and interviews. The authors also discuss the ethical principles set by CNS Resolution 196/96 and other ethical questions, whose solutions should be based on the agreement between researchers and subjects.

[Analysis of the care delivered to hospitalized newborns according to the Winnicottian perspective]. / Análise do cuidado ao bebê hospitalizado segundo a perpectiva Winnicottiana.

This work aimed to analyze the holding provided by nurse aides, nurses, mothers, and fathers to infants newborn hospitalized at the middle risk neonatal unit of a university hospital in the city of São Paulo. This is a qualitative descriptive study based on Winnicott's theoretical framework. Data were collected by means of videotaping. Results demonstrated that there are some professionals who fail in providing holding, whereas others provide it satisfactorily. Although parents provide adequate holding, at times they fail to do so. We believe that it is necessary that the caring practice must be reevaulated, so that all members of the team, and also mothers and fathers are able to provide adequate holding for the infant's development.

Polysomnography assessment of sleep and wakefulness in premature newborns.

OBJECTIVE: to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD: a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS: the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION: the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Risk and protective factors for sudden infant death syndrome / Factores de riesgo y de protección para la síndrome de la muerte súbita del lactante / Fatores de risco e de proteção para a síndrome da morte súbita do lactente

ABSTRACT Objectives: To verify the occurrence of the risk and protective factors for sudden infant death syndrome during nursing consultation. Methods: Retrospective cohort study conducted based on medical records from a primary care unit in the municipality of São Paulo. The sample consisted of 63 infants assisted from January to December 2016. Results: The average age of infants was 3.2 months. The main risk factors identified were the presence of soft objects in the crib (93.6%) and bed sharing (58.7%). Predominant protective factors were breastfeeding (95.2%) followed by updated immunization (90.5%). Conclusions: Risk and protective factors for sudden infant death syndrome were identified in the study sample, indicating the importance of addressing the issue with families of children under 1 year of age to prevent the occurrence of such events.

RESUMEN Objetivos: Verificar la ocurrencia de factores de riesgo y de protección para la síndrome de la muerte súbita del lactante durante consulta de enfermería. Métodos: Estudio de cohorte retrospectivo conducido a partir de registros en prontuario de salud de servicio de atención primaria del municipio de São Paulo. La muestra ha sido compuesta por 63 lactantes atendidos en el período de enero a diciembre de 2016. Resultados: La media de edad de los lactantes ha sido de 3,2 meses. Los principales factores de riesgo identificados han sido la presencia de objetos blandos/suaves en la cuna (93,6%) y el compartir de lecho (58,7%). Factores de protección predominantes han sido: amamantamiento materno (95,2%) seguido de inmunización actualizada (90,5%). Conclusiones: Han sido identificados factores de riesgo y de protección para la síndrome de la muerte súbita del lactante en la muestra estudiada, indicando la importancia del abordaje de la temática junto a las familias de niños menores de 1 año, para prevención de la ocurrencia de tales eventos.

RESUMO Objetivos: Verificar a ocorrência de fatores de risco e de proteção para a síndrome da morte súbita do lactente durante consulta de enfermagem. Métodos: Estudo de coorte retrospectivo conduzido a partir de registros em prontuário de saúde de serviço de atenção primária do município de São Paulo. Amostra foi composta por 63 lactentes atendidos no período de janeiro a dezembro de 2016. Resultados: A média de idade dos lactentes foi de 3,2 meses. Os principais fatores de risco identificados foram presença de objetos macios no berço (93,6%) e o compartilhamento de leito (58,7%). Fatores de proteção predominantes foram: aleitamento materno (95,2%) seguido de imunização atualizada (90,5%). Conclusões: Foram identificados fatores de risco e de proteção para a síndrome da morte súbita do lactente na amostra estudada, indicando a importância da abordagem da temática junto às famílias de crianças menores de 1 ano, para prevenção da ocorrência de tais eventos.

Risk and protective factors for sudden infant death syndrome / Factores de riesgo y de protección para la síndrome de la muerte súbita del lactante / Fatores de risco e de proteção para a síndrome da morte súbita do lactente

ABSTRACT Objectives: To verify the occurrence of the risk and protective factors for sudden infant death syndrome during nursing consultation. Methods: Retrospective cohort study conducted based on medical records from a primary care unit in the municipality of São Paulo. The sample consisted of 63 infants assisted from January to December 2016. Results: The average age of infants was 3.2 months. The main risk factors identified were the presence of soft objects in the crib (93.6%) and bed sharing (58.7%). Predominant protective factors were breastfeeding (95.2%) followed by updated immunization (90.5%). Conclusions: Risk and protective factors for sudden infant death syndrome were identified in the study sample, indicating the importance of addressing the issue with families of children under 1 year of age to prevent the occurrence of such events.

RESUMEN Objetivos: Verificar la ocurrencia de factores de riesgo y de protección para la síndrome de la muerte súbita del lactante durante consulta de enfermería. Métodos: Estudio de cohorte retrospectivo conducido a partir de registros en prontuario de salud de servicio de atención primaria del municipio de São Paulo. La muestra ha sido compuesta por 63 lactantes atendidos en el período de enero a diciembre de 2016. Resultados: La media de edad de los lactantes ha sido de 3,2 meses. Los principales factores de riesgo identificados han sido la presencia de objetos blandos/suaves en la cuna (93,6%) y el compartir de lecho (58,7%). Factores de protección predominantes han sido: amamantamiento materno (95,2%) seguido de inmunización actualizada (90,5%). Conclusiones: Han sido identificados factores de riesgo y de protección para la síndrome de la muerte súbita del lactante en la muestra estudiada, indicando la importancia del abordaje de la temática junto a las familias de niños menores de 1 año, para prevención de la ocurrencia de tales eventos.

RESUMO Objetivos: Verificar a ocorrência de fatores de risco e de proteção para a síndrome da morte súbita do lactente durante consulta de enfermagem. Métodos: Estudo de coorte retrospectivo conduzido a partir de registros em prontuário de saúde de serviço de atenção primária do município de São Paulo. Amostra foi composta por 63 lactentes atendidos no período de janeiro a dezembro de 2016. Resultados: A média de idade dos lactentes foi de 3,2 meses. Os principais fatores de risco identificados foram presença de objetos macios no berço (93,6%) e o compartilhamento de leito (58,7%). Fatores de proteção predominantes foram: aleitamento materno (95,2%) seguido de imunização atualizada (90,5%). Conclusões: Foram identificados fatores de risco e de proteção para a síndrome da morte súbita do lactente na amostra estudada, indicando a importância da abordagem da temática junto às famílias de crianças menores de 1 ano, para prevenção da ocorrência de tais eventos.