日夜週期性光照介入早產兒照護之實證

Effect of Cycled Light for Preterm Infants

早產兒在矯正胎齡30至31週時即開始對光照有反應，藉由提供日夜週期性光線，即白天提供光線，到了夜晚關閉光源，可以營造一個合乎身體活動與休息的晝夜節律，陸續有許多研究探討日夜週期性光線對早產兒生長發育、行為反應及睡眠之成效，但目前國内相關研究仍缺乏且無整合性文獻，故本文目的即以系統性文獻回顧方式，整合日夜週期性光線介入早產兒照護之實證。限定2002年至2017年10月前發表的中英文文獻，於The Cochrane Library、PubMed、Medline、ProQuest、華藝線上圖書館五個資料庫中搜尋，最後共得7篇隨機對照試驗。研究結果發現，小兒照護病房不建議採持續性光亮環境，而曰夜週期性光線能讓早產兒較快發展晝夜節律且返家後哭泣、出現激動行為時間較少，但與持續提供近全黑的環境相比，其對體重增加成效則尚未有證據支持，另外，建議早產兒出生或32週時即可開始執行曰夜週期性光線，此有助於早產兒體重增加，而在常規採取日夜週期性光線後，醫護人員夜間照護採取LED紅光或白光並不影響早產兒生長，本研究結果期作為早產兒照護環境之參考依據。 Abstract: The pupillary light reflex develops between 30 and 31 weeks' corrected age in preterm infants. Providing the cycled lighting environment with lights on during daytime and lights off at night to develop circadian rest-activity rhythms. Recently, more studies were to explore cycled lighting in neonatal care on infant growth, behavior, and sleep patterns. However, related research and systematic review in this field still lacks. The aim of the study was to perform a systematic review to summarize the effectiveness of cycled light for preterm infants. This review focused on studies published between 2002 and 2017 and the following databases were searched: The Cochrane Library, PubMed, MEDLINE, ProQuest, and Airiti Library. Seven randomized controlled studies met the inclusion criteria. The results showed that infants in the pediatric intensive care units were not recommended to expose to a continuously bright environment. The cycled lighting conditions in neonatal care had beneficial effects to facilitate infant’s development of circadian rhythms and reduced fussing and crying behavior after returning home. Compared with continuously dim light, exposed preterm infants to cycled lighting did not have significant effect on weight gain. However, preterm infants received cycled lighting from birth or at 32 weeks gained weight significantly faster. Furthermore, no significant difference in growth was found between preterm infants exposed to white or red LED light for regular nursing care during nighttime in a light-dark cycle. These results can be used as a reference for caring preterm infants.

Abstract: The pupillary light reflex develops between 30 and 31 weeks' corrected age in preterm infants. Providing the cycled lighting environment with lights on during daytime and lights off at night to develop circadian rest-activity rhythms. Recently, more studies were to explore cycled lighting in neonatal care on infant growth, behavior, and sleep patterns. However, related research and systematic review in this field still lacks. The aim of the study was to perform a systematic review to summarize the effectiveness of cycled light for preterm infants. This review focused on studies published between 2002 and 2017 and the following databases were searched: The Cochrane Library, PubMed, MEDLINE, ProQuest, and Airiti Library. Seven randomized controlled studies met the inclusion criteria. The results showed that infants in the pediatric intensive care units were not recommended to expose to a continuously bright environment. The cycled lighting conditions in neonatal care had beneficial effects to facilitate infant’s development of circadian rhythms and reduced fussing and crying behavior after returning home. Compared with continuously dim light, exposed preterm infants to cycled lighting did not have significant effect on weight gain. However, preterm infants received cycled lighting from birth or at 32 weeks gained weight significantly faster. Furthermore, no significant difference in growth was found between preterm infants exposed to white or red LED light for regular nursing care during nighttime in a light-dark cycle. These results can be used as a reference for caring preterm infants.