Intensive Crit Care Nurs. 2025 Jul 31;91:104168. doi: 10.1016/j.iccn.2025.104168. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate and compare the efficacy of nonpharmacological interventions on sleep-wake states among preterm infants in NICUs through a network meta-analysis (NMA).
METHODS: This study conducted a systematic review and network meta-analysis. A systematic search of the PubMed, Embase, ProQuest, and CINAHL databases was conducted from inception to September 11, 2024. The NMA included randomized controlled trials (RCTs) on the effects of nonpharmacological interventions on sleep disturbances in preterm infants (aged < 37 weeks) in NICUs. Data were independently extracted and analyzed by two reviewers using a random-effects model. The risk of bias was assessed using Cochrane’s RoB 2.0 tool. Strength of evidence was assessed using the Confidence in NMA tool.
RESULTS: Seventeen RCTs involving 709 preterm infants and 11 interventions were included. Touch and massage combined with kangaroo care (T + M + KC) most effectively improved the proportion of time spent in the active (20.41 %; 95 % confidence interval = 0.06-40.77) and quiet (8.33 %; 95 % confidence interval = 3.97-12.69) sleep phases compared with standard care. The P-score analysis supported this finding, revealing that T + M + KC was the most likely to be the optimal nonpharmacological treatment for both active (96 %) and quiet (94 %) sleep, followed by NIDCAP, which ranked second for active (83 %) and quiet (73 %) sleep. Most studies (64.7 %) demonstrated a low risk of bias, and most comparisons across sleep-wake states received a high confidence rating.
CONCLUSIONS: T + M + KC was the most effective, cost-efficient, and noninvasive intervention for improving sleep in preterm infants. Future large-scale, high-quality RCTs are necessary to confirm these findings and evaluate long-term outcomes.
IMPLICATIONS FOR CLINICAL PRACTICE: T + M + KC represents a safe, cost-effective, and noninvasive intervention that can be feasibly implemented in NICUs to improve sleep outcomes in preterm infants. Training NICU staff to apply multimodal, sensory-based care can enhance neurodevelopmental outcomes and reduce sleep disruptions, ultimately supporting healthier growth trajectories in this vulnerable population.
PMID:40749355 | DOI:10.1016/j.iccn.2025.104168
