Effect of Swaddling on Sleep Period of Preterm Infants
Preterm infants in the neonatal care unit receive excessive stimulation from the environment. This environment is different from the mother’s womb and affects sleep duration, the development of the central nervous system, and can lead to an abnormal sensory system in preterm infants. Fortunately, swaddling is a method that can be used to help preterm infants have longer sleep periods. The study aimed to compare the effects of swaddling and standard nursing care on the sleep states of preterm infants. Fourteen preterm infants postconceptional aged between 32-36 weeks admitted to neonatal care unit at Chiang Rai Prachanukroh Hospital were studied. The study used a one group cross-over experimental design. The control group received routine nursing care and the experiment group received the swaddle. The researcher observed and recorded by videotape the participant’s sleep and recorded the noise levels for a period of 2 hours. The researcher observed the sleep-wake states of preterm infants and recorded using Penjit Thanacharoenpipat’s methods and form (Thanacharoenpipat, 2001) . Environmental sound levels were also recored using Salisa Kodyee’s methods and form (Kodyee, 2015). The recorded data were analyzed using descriptive statistics as dependent sample t-test. Wilcoxon Matched Pairs Singed-Ranks Test was used for matched pairs. The study found that:
- The mean duration of total sleep in the group using the swaddle was statistically significantly greater than the control group receiving routine nursing care (p<.05)
- The mean duration of deep sleep in the group using the swaddle was statistically significantly greater than the control group receiving routine nursing care (p<.05)
The findings of this study indicated that swaddling can promote a longer duration of deep sleep and greater total sleep than routine nursing care. This study could be used as a guide for improving the duration of sleep in preterm infants.
Alden, K. R. (2016). Nursing care of the newborn and family. In D. L. Lowdermilk, S. E. Perry, K. Cashion, & K. C. Alden (Eds.), Maternity & women’s health care (11th ed., pp. 549-600): Elsevier.
Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3(4), 229–243.
American Academy of pediatric. (1997). Noise: A hazard for the fetus and newborn. Pediatrics, 100(4), 724-727.
Ballard, J. L., Khoury, J. C., Wedig, K. L., Wang, L., Eilers-Walsman, B. L., & Lipp, R. (1991). New ballard score, expanded to include extremely premature infants. The Journal of Pediatrics, 119(3), 417-423.
Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., & Lawn, J. E. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. The Lancet, 379(9832), 2162-2172. doi: 10.1016/S0140-6736(12)60820-4
Burns, N., & Grove, S. K. (2009). The practice of nursing research appraisal, synthesis, and generation of evidence (6thed.). Missouri: Saunser.
Calciolari, G., & Montirosso, R. (2011). The sleep protection in the preterm infants. The Journal of Maternal-Fetal & Neonatal Medicine, 24(sup1), 12-14.
Department of Health (2016). Annual report. Bongkok: Ministry of pubiic health. Retrirved Agust 28, 2016, from http://planning.anamai.moph.go.th/main.php?filename=Left_M2_3
Franco, P., Seret, N., Van Hees, J. N., Scaillet, S., Groswasser, J., & Kahn, A. (2005). Influence of
swaddling on sleep and arousal characteristics of healthy infants. Pediatrics, 115(5), 1307-1311. doi: 10.1542/peds.2004-1460
Gardner, S. L., Garland, K. R., Merenstein, S. L., & Lubchenco, L. O. (1993). The neonatal and the environment: Impact on development. In G.B. Merenstein, & S. L. Garder (Eds), Handbook of neonatal intensive care (3rded). Missouri: Mosby-Year Book.
Gerard, C. M., Harris, K. A., & Thach, B. T. (2002). Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics, 110(6), e70.
Gorzilio, D. M., Garrido, E., Gaspardo, C. M., Martinez, F. E., & Linhares, M. B. M. (2015). Neurobehavioral development prior to term-age of preterm infants and acute stressful events during neonatal hospitalization. Early human development, 91(12), 769-775.
Holditch-Davis, D. (2010). Development of sleep and sleep problems in preterm infants. Encyclopedia on Early Childhood Development, 1-8.
Holditch-Davis, D., & Blackburn, S. T. (2014). Neurobehavioral development. In L. C. Kenner & J. W. Lott (Eds.), Comprehensive neonatal nursing (pp. 689-721). Springer Publishing Company, LLC.
Horpaopan, S., Thaitumyanon, P., & Jirapaet, K., (2008). Neonatal 2008. Bangkok: Thana Place&Graphic.
Kansa, R., (2012). Nervous system. In R. Kansa (Eds.), Physiology 1 (p 83-297). Nonthaburi: Thana Place.
Kodyee, S., (2015). Effect of noise reduction cap usage on sleep-wake states of hospitalized preterm infants (Master of Nursing Science Thesis, Pediatric nursing). Graduate School, Chiang Mai university. (In Thai)
Lasky, R. E., & Williams, A. L. (2009). Noise and light exposures for extremely low birth weight newborns during their stay in the neonatal intensive care unit. Pediatrics, 123(2), 540-546. doi: 10.1542/peds.2007-3418
Lipton, E. L., Steinschneider, A., & Richmond, J. B. (1960). Autonomic function in the neonate II: Physiologic effects of motor restraint. Psychosomatic Medicine, 12(1).
Merenstein, G. B., & Gardner, S. (2011). The neonatal and the environment: Impact on development.
In G.B. Merenstein, & S. L. Garder (Eds), Handbook of neonatal intensive care (8rded). Missouri: Elsevier
Ranganna, R., & Bustani, P. (2011). Reducing noise on the neonatal unit. Infant, 7(1), 25.
Tarullo, A. R., Balsam, P. D., & Fifer, W. P. (2011). Sleep and infant learning. Infant and Child Development, 20(1), 35-46. doi: 10.1002/icd.685
Thanacharoenpipat, P., (2001). Effects of Positioning on Duration of Sleep among Premature Infants (Master of Nursing Science Thesis, Pediatric nursing). Graduate School, Chiang Mai university. (In Thai)
Volpe, J. J. (2001). Neurological examination: Normal and abnormal features. Neurology of the newborn (4th ed., pp.103-133). Philadelphia: W.B. Saunders Company.
Werth, J., Atallah, L., Andriessen, P., Long, X., Zwartkruis-Pelgrim, E., & Aarts, R. M. (2016). Unobtrusive sleep state measurements in preterm infants–A review. Sleep Medicine Reviews. doi: 10.1016/j.smrv.2016.03.005
World Health Organisation Global Health Observatory. (2015). Preterm birth. Retrieved from
Zahr, L. K., & Balian, S. (1995). Responses of premature infants to routine nursing interventions and noise in the NICU. Nursing Research, 44(3), 179-185.
Zarei, K., Shariat, M., Nikafs, N., & Sepaseh, H. (2018). Correlations of Handling Procedures and Sleep Patterns of the Infants Admitted to the Neonatal Intensive Care Unit. Iranian Journal of Neonatology IJN, 9(3), 35-41.