Light-Dark Cycle: Weight Gain and Reduction in Length of Stay in Premature NICU Infants Volume 54- Issue 2

María José Cano Chi², Miguel Elias García Moreno², Saul May Uitz¹* and Genny Josefina Madera Poot¹

• ¹Career teacher, Autonomous University of Yucatan, Mexico
• ²Nursing student of the Specialty in Intensive Care Nursing, Autonomous University of Yucatan, Mexico

Received: December 07, 2023; Published: January 04, 2024

*Corresponding author: Saul May Uitz, Career teacher, Autonomous University of Yucatan, Mexico

DOI: 10.26717/BJSTR.2024.54.008540

Abstract PDF

Objective: To describe how the light-dark cycle has a positive effect on weight gain and reduction of days of hospital stay in premature patients in the Neonatal Intensive Care Unit.

Methods: Qualitative research, literature review type, question formulated in IOP format, terms were listed for translation into scientific language by means of queries in DeCS and MeSH, for the creation of search strings, the sources consulted for localization were: VHL, Cochrane Library, Google search engine, Espistemonikos, Wolters Kluwer. As a strategy for an accurate search, the AND operator was used, as well as free terms. We included studies with randomized clinical trial designs and systematic reviews, published from 2013 onwards and studies in premature populations. The screening process was carried out by means of the PRISMA declaration; the quality was evaluated by FLC 3.0.

Results: A total of 148 articles were retrieved, of which 134 were eliminated because they did not contain useful information, duplication or inaccessibility. 5 more were discarded due to their lack of contribution to the topic and their low quality of information. 100% (9) articles were eligible, whose designs are: 88.88% (8) high-quality and medium-quality clinical trials, 11.12% (1) high-quality systematic review. The OCEBEM scale was used to assign the level of evidence and degree of recommendation, with a gradation of "A" and level "1c".

Conclusion: The light-dark cycle in premature patients in the Neonatal Intensive Care Unit favors weight gain and decreases their hospital stay, improving their speedy recovery.

Keywords: Light; Dark; Preterm; Weight Gain; Neonatal Intensive Care Unit

Abbreviations: IOP: Intervention Population Outcome; RN: Newborn; PTNN: Reterm Newborn; DeCS: Descriptors in Health Sciences; MeSH: Medical Subjects Headings; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; FLC: Critical Reading Worksheets; OCEBM: Center for Evidence- Based Medicine Oxford, CL-O: Light Dark Cycle; NICU: Neonatal Intensive Care Unit

The change that a newborn undergoes to life outside the womb begins with its first breaths and the interruption of maternal-fetal circulation, which produces physiological, hemodynamic and respiratory changes [1]. The newborn is the product of conception from birth to 28 days; and the preterm newborn (PTNN) whose gestation was from 22 to less than 37 weeks. When gestational age is not known, a product weighing less than 2,500 grams will be considered preterm [2]. Prematurity is the leading cause of neonatal morbidity and mortality. Most of the sequelae derived from prematurity are usually neurological, pulmonary and digestive. The lower the weight and gestational age, the greater the risk of health problems [3]. The more premature a baby is, the more sensitive it is to light, so it is recommended to use a suitable light environment, which helps reduce cortisol levels, prolongs the duration of sleep, stimulates the release of growth hormones and favors the early development of a circadian rhythm. This, through the use of the light-dark cycle (CL-O); Studies show beneficial effects on PTRN such as: less anxiety, better rest and greater reactivity during the day [4]. Although some studies diverge on when to establish a circadian rhythm in the RNPT: Morag in 2008 mentions that by performing 12 hours of light and 12 hours of darkness it is possible to simulate the changes of external light [5].

Another intervention by Castellanos and Escobar showed that by establishing a light-dark cycle in an experimental group, there was a better tolerance to food compared to the group that was exposed to constant light conditions. This had a direct result in weight gain and reduced hospital stay [6]. International and national studies [7-9] mention that PTRNs who are exposed to CL-O (as is often the case in the neonatal intensive care unit (NICU) show improvement in terms of rest, tolerance to food, weight gain, reduction in hospital stay and decreased risk of contracting nosocomial diseases secondary to prolonged hospitalization. CL-O is a feasible intervention to be performed and monitored by nursing staff, and it is even an activity that is routinely implemented in NICUs. However, it is carried out for other therapeutic purposes such as maintaining euthermy, improving rest or measuring comfort. This intervention, in addition to not being an invasive procedure for premature infants; It is low-cost, innovative and scientifically supported, which demonstrates the potential that this activity has in the practice of nursing in neonatal critical care units. Based on the above, the objective of this study is the effectiveness of the light-dark cycle in increasing body weight and reducing hospital stay in premature patients in the NICU.

Qualitative research, of the literature review type, the research question was formulated according to the Population, Intervention and Outcome (IOP) model. The study variables were: light-dark cycle, preterm infants in the intensive care unit, weight gain, and hospital reduction. The selection and discarding process of the articles was carried out with the support of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement [10], the evidence and degrees of recommendation of the localized evidence were evaluated and finally assigned.

A team of two reviewers was formed to search for evidence. The location was independent. Data collection was divided into two periods: the first was from August 27 to September 15, 2023, while the second was from September 18 to October 10, 2023. The data obtained from the different articles located were tabulated in logs using Microsoft Word software. During the search protocol for scientific articles, all those studies that met the following criteria were considered as study populations:

1) Scientific articles with a randomized clinical trial design and systematic review,

2) Generated within the period from 2013 to 2023,

3) With relevance to the topic: light/dark cycle for weight gain and reduction of hospital stay in premature infants,

4) In Spanish, English, Portuguese and French.

Evidence collection focused on locating articles that were relevant to the topic and population of the study. The documentary sources consulted during the search for the articles were: Virtual Health Library (VHL) [11], Cochrane Library [12], Epistemonikos [13] and Wolters Kluwer [14]. A free query was also carried out, without the use of specific search strings, in the Google search engine [15]. As a strategy for an effective search, the Boolean operator (DNA) was used, together with keywords whose documentary terms will be found in the MeSH [16] and DeCS [17]: infant premature, Intensive Care Units Neonatal, light, Darkness and Weight Gain. In order to locate as many items as possible, it was decided to add the following free terminology: cycle, light/dark cycle and premature. Each of the words described above were translated into Spanish, English, Portuguese and French. In addition to the above, the following primary search chains were formed: "light/dark cycle AND premature AND weight gain", "Cycle AND weight gain AND premature" and "infant Premature AND Intensive Care Units Neonatal AND light AND Darkness Weight Gain". Subsequently, the analysis of the variables presents in the titles and abstracts of the identified articles began. Regarding the use of the light-dark cycle; Their focus population, the objective of the intervention, and the use of the cycle during the research were evaluated. Regarding the variables of weight gain and reduction of hospital stay, the aim was for the article to mention at least one of the two in its methodology or results. Finally, it was also assessed that the study population was preterm infants in the Neonatal Intensive Care Unit (NICU).

After conducting a literature search to locate significant evidence, in accordance with the inclusion criteria in the aforementioned search engines, a total of 148 articles were identified See Figure 1. Of these, 134 were eliminated because they did not meet the aforementioned criteria, 14 were chosen for a complete critical reading, however 5 were eliminated due to their deficient contribution to the topic and low quality of the information, finally 9 (100%) articles were chosen, whose designs were 1 (11.12%) systematic review and 8 (88.88%) randomized clinical trials evaluated with the Critical Reading Sheets (FLC) version 3.0 platform [18]. The interpretation used to assign the level of evidence and the degree of recommendation of the selected articles was developed using the scale of the Center for Evidence-Based Medicine, Oxford (OCEBM) [19] See Table 1. Obtaining a level of evidence 1c and a recommendation grade A.

Figure 1

Table 1: Synthesis and Gradation of Evidence.

During the review, it was found that C-LO has a significant impact on weight gain, which coincides with a study conducted by Brandon Debra in 2018, who showed that the average weight gain was 193.8 grams in a group exposed to the cycle compared to 176.3 grams in the group without the exposure to the cycle [20]. On the other hand, a study carried out in 2012 by Guyer also supports the effectiveness of C-LO in increasing daily weight. [21] Another result that was found during the review was that C-LO decreases hospital stay, Brandon Debra in 2018 mentions that preterm infants in the group exposed to the cycle returned home on an average of 5 days earlier than preterm infants who did not have an exposure to the cycle [22]. During the review, it was found that C-LO exposure causes an improvement in oxygen saturation, in agreement with the study carried out by Castellanos in 2012 in which it was evidenced that they presented improvement in oxygen saturation, measured through pulse oximetry [23-31].

Achieving adequate lighting in the NICU is a major challenge, due to the lack of protocols in medical units for light regulation used in neonatal intensive care units. It is intended to be a work so that, together with other future research, a safe lighting environment can be achieved and favors the adequate development of the premature newborn hospitalized in the NICU for weight gain and reduction of hospital stay.

To our families who were a pillar of support, to our friends, to our advisors and to our alma mater: the Autonomous University of Yucatan.

The authors declare that they have no conflict of interest in relation to this work.

1. Saliba E, Lopez E, Storme L, Tourneux P, Favrais G (2018) Fisiología del feto y del recién nacido. Adaptación a la vida extrauterina. EMC – Pediatría 53(2): 1-29.
2. (2023) NORMA Oficial Mexicana NOM-007-SSA2-2016, Para la atención de la mujer durante el embarazo, parto y puerperio, y de la persona recién nacida.
3. Adelantado HS, Roglá MC (2023) 3. Cuidados de enfermería en una unidad de cuidados intensivos pediátricos y neonatales. 57: 55-81.
4. Roberto G Rodriguez, Dra Andrea E pattini (2016) luminoso en cuidados intensivos neonatales. Arch Argent Pediatr 114(4): 361-367.
5. Morag I, Ohlsson A (2016) Cycled light in the intensive care unit for preterm/low birth weight infants. Cochrane Database of Systematic Reviews (8): CD006982.
6. Castellanos Manuel Ángeles, Escobar Carolina De la (2016) cronobiología a la cronomedicina. Rev Fac Med (Mé) 59(2): 15-23.
7. Miquel Capó, RN I (2016) Intervenciones enfermeras sobre el ambiente físico de las Unidades de Cuidados Intensivos Neonatales. Enfermería Intensiva 27(3): 96-111.
8. Betancourt E Eugenia C Fuentes (2011) Ruido iluminación y manipulación en recién nacidos en una UCIN. Revista de Enfermeria del Instituto Mexicano del Seguro Social 19(3).
9. Sola B CONACYT Beneficios de la oscuridad para los bebés prematuros.
10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, et al. (2021) Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemá Rev Esp Cardiol 74(9): 790-799.
11. Portal Regional da BVS.
12. Cochrane reviews.
13. Epistemonikos: El más rápido y confiable buscador de evidencia en salud.
14. Wolters Kluwer.
16. MeSH – NCBI.
17. DeCS-MeSH Finder – Advanced.
18. Fichas de Lectura Crítica.
19. Sousa MM, Sousa M, Navas Z, Laborde M, Alfaro B, et al. Niveles de Evidencia Clínica y Grados de Recomendació
20. Brandon D, Silva S, Park J, Malcolm W, Kamhawy H (2017) Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized Controlled Trial. Res Nurs Health 40(4): 294-310.
21. Guyer C, Huber R, Fontijn J, Bucher HU, Nicolai H, et al. (2012) Cycled light exposure reduces fussing and crying in very preterm infants. Pediatrics 130(1): e145-151.
22. Ángeles M, Vázquez S, Palma M, Ubaldo L, Cervantes G, et al. (2013) Desarrollo de los ritmos biológicos en el recién nacido. Cátedra Especial "Dr. Ignacio Chávez". Rev Fac Med (Mé) 56(3): 26-35.
23. Sánchez M, García TL, Heredia D, Reséndiz I, Cruz L, et al. Efecto de un ciclo de luz-oscuridad sobre el aumento de peso corporal de recién nacidos prematuros ingresados en la unidad de cuidados intensivos neonatales. Sci Rep 12(1): 17569.
24. Esmaeilizadeh M, Shoja M, Shoja E, Shoja M, Nejat H, et al. Comparación de los efectos de las iluminaciones continuas y cíclicas en el aumento de peso y duración de la estancia hospitalaria entre recién nacidos prematuros. Mod Care J 13(1): e8951.
25. Marzouk S, Abdrbou H, Mohamed S (2019) Efectividad de la iluminación cíclica en la unidad de cuidados intensivos neonatales sobre el peso y función cardiorrespiratoria en bebés prematuros. International Journal of Paediatrics and Geriatrics 2(1): 18-24.
26. Çetin K, Ekici B El efecto de la cubierta de la incubadora sobre los signos vitales del recién nacido: el diseño de mediciones repetidas en dos grupos separados sin grupo de control. Niños 10(7): 1224.
27. Sánchez M, García TL, Heredia D, Reséndiz I, Cruz L, et al. (2022) Efecto de un ciclo de luz-oscuridad sobre el aumento de peso corporal de recién nacidos prematuros ingresados en la unidad de cuidados intensivos neonatales. Sci Rep 12(1): 17569.
28. Dilek Küçük Alemdar, Sevil İnal (2020) El efecto de las prácticas de atención individualizada del desarrollo en bebés prematuros. Complemento Med Res 27 de abril de 27(2): 97-104.
29. Kaneshi Y, Ohta H, Morioka K, Hayasaka I, Uzuki Y, et al. (2016) Influencia de la exposición a la luz nocturna sobre el desarrollo del sueño y el crecimiento corporal de los bebés prematuros. Sci Rep 6(1).
30. Vásquez S, Maya JA, Torres P, Vega BR, Rojas A, et al. (2014) Un ciclo de luz/oscuridad en la UCIN acelera el aumento de peso corporal y acorta el tiempo hasta el alta en lactantes prematuros. Early Hum Dev 90(9): 535-540.
31. Morag I, Ohlsson A (2016) Luz ciclada en la unidad de cuidados intensivos para lactantes prematuros y de bajo peso al nacer. Cochrane 2020(1).