INTRODUCTION:

The birth of an infant is one of the most owe inspiring and emotional event that can occur in one’s life time. After nine months of anticipation and preparation the neonate arrives amid a flurry of excitement.¹ Proper care of the newborn babies forms the foundation for the qualitative outcome without any mental and physical disabilities. Infant sleep development is a highly dynamic process occurring in parallel to and in interaction with cognitive and physical growth.² Sleep develops rapidly during the first few years of life. At birth, infants lack an established circadian rhythm and hence sleep across multiple intervals throughout the day and night in short bouts, which may also be due to infants feeding needs.³ Each baby has a different sleep pattern.

Sleep has a regulatory role in bodies. It is a basic biological need, and it is considered a mechanism of body protection. Changes in the sleep pattern of a child have direct effects on the child development, especially in the early stages of childhood, whose chronological age is based on developmental milestones. In addition, sleep disorders during the first years of a child’s life are more severe and intractable. (Ana Carolina Dantas, 2016).⁴

Swaddling is a way of wrapping a baby in a blanket to make him or her feel safe and cozy. It also prevents the startle reflex from waking the baby up. This method has been used by parents for thousands of years. Swaddling is a perfect way to calm down fussy babies. Many parents swaddle their babies to help them sleep for longer periods of time. It can be used to calm a baby who is crying for no apparent cause. A blanket wrapped snuggly around baby’s body can resemble the mother’s womb and help soothe newborn baby.⁵ The American Academy of Pediatrics (AAP) says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep.⁶

Infant swaddling was almost a universal practice. It involved binding or bundling babies in blankets with the arms restrained and the lower limbs extended. It remains common in the Middle East1 and in some ethnic groups with or without a board or cradle. There has been a recent resurgence of swaddling because of its perceived palliative effect on excessive crying, colic and promoting sleep. Approximately 90% of infants in North America are swaddled in the first few months of life. A recent systemic review concluded that in general swaddled infants do arouse less and sleep longer. Preterm infants showed improved neuromuscular development. (N M P Clarke, 2014).⁷

In this research, it has been evaluated that if swaddling technique plays an efficient role in promoting sleep pattern among newborns.

MATERIALS AND METHODS:

Materials:

Anders and Chalemian Sleep Scoring.⁸

This Tool Has 6 Items Actions Monitored Include:

1. No Fussy-cry (FC): Vigorous diffuse motor activity and varying intensities of vocalization (crying)

2. No Wakeful activity (WA): Frequent spurts of diffuse motor activity, open eyes, and occasional grunts and whimpers

3. No Alert inactivity (Al): Occasional directed motor actions and wide-open eyes that pursued targets

4. Not Drowsy (DR): Relative immobility, absence of focused attention, and opening and closing of the eyelids.

5. Active/REM Sleep (AR): Rapid eye movements, facial grimacing, writhing body movements, isolated limb twitches, and irregular respiration

6. Quiet NREM sleep (QS): Absence of eye movements and body movements except for an occasional startle or burst of non nutritive sucking, and the presence of regular respiration

Action Points
Did not occur	-	0
Occurred	-	1

Interpretation:

· Minimum score: 0

· Maximum score for full term newborns: 6 Mild Sleep-0 – 2

Moderate Sleep - 3 – 4

Deep Sleep- 5 – 6

Methods:

The study was conducted in Ashwin Hospital, Coimbatore. In this study, 60 newborns in Ashwin hospital who are full term newborns, formed the population. The hospital was selected by using convenient sampling method. Convenience sampling is a non probability sampling technique where subjects are selected because of their convenient accessibility and proximity to the researcher. Samples were assigned as 30 newborns in the experimental group and 30 newborns in the control group. In this study, the researcher applied swaddling technique for experimental group.

Swaddling Techniques:

Protocol:

Swaddling techniques are developmentally used non-pharmacological techniques by the nurses or other health personnel in order to increase sleep pattern in newborn babies. Swaddling increases a baby's total amount of sleep as well as nonrapid eye movement (NREM) or light sleep compared with when they were not swaddled. (9) It is easy to done and less cost effective.

Aim:

Assess the effectiveness of the swaddling technique to increase sleep pattern in newborns. A blanket at least 40 by 40 inches (100 cm × 100 cm) is used for swaddling technique.

Procedure:

a) Preparatory Stage:

· Establish a therapeutic relationship by building rapport and gain the confidence of the newborn babies parents

· Explain about the procedure and swaddling technique to the parents and nurses.

· Clear the doubts of the parents

· Get oral consent from the parents

· Arrange cotton clothes in the procedure room before the procedure start.

b) Intervention Stage:

1. Lay out the blanket on a flat surface. such as your bed or a padded floor. Arrange it in a diamond shape. The blanket should be at least 40 by 40 inches (100 cm × 100cm).¹⁰

2. Fold down the top corner of the blanket.

3. Place the baby face-up on the blanket.

4. Take your baby’s left arm and carefully straighten it.

5. Pull the wrap around the baby’s body to the right side.

6. Move the baby's right arm into position.

7. Tuck the other side of the blanket under the baby’s left side.

8. Close the bottom of the swaddle. Loosely fold up or twist the bottom of the blanket to cover the baby’s feet.

9. The researcher has to swaddle the baby and watch for the behavioral changes by using Anders And Chalemian Sleep Scoring.

c) Termination Phase:

· Assess the newborn baby’s reaction

· Make the newborns and parents comfort.

RESULT:

Table 1: Frequency and percentage distribution of demographic variables among newborns in the experimental and the control group. (N=60)

Demographic variables	Experimental group (n = 30)		Control group (n = 30)
Demographic variables	f	%	f	%
1. Age:
a. 1 – 14 days	25	83.33	23	76.67
b. 14 – 28 days	5	16.67	7	23.33
2. Sex:
a. Male	20	66.67	13	43.33
b. Female	10	33.33	17	56.67
3. Weight:
a. < 2 kg	0	0	1	3.33
b. 2 – 3 kg	23	76.67	20	66.67
c. > 3 kg	7	23.33	9	30
4. Time of birth:
a. Daytime	24	79.9	8	26.67
b. Night	6	20.1	22	73.33
5. Mode / Type of Delivery:
a. Normal	24	79.9	26	86.67
b. Caesarean	6	20.1	4	13.33

Fig:1.1. Distribution of Samples in terms of age in the experimental and control group.

Fig: 1.2. Distribution of Samples in terms of sex in the experimental and control group.

Fig: 1.3. Distribution of Samples in terms of weight in the experimental and control group.

Fig: 1.4. Distribution of Samples according to the time of birth in the experimental and control group.

Fig: 1.5. Distribution of Samples according to the type of Delivery in the experimental and control group.

Table 2.: Frequency and percentage distribution according to the pretest and posttest levels of sleep scores among newborns in the experimental group.

Sleep score	Experimental Group (n = 30)
	Pre test		Post test
	f	%	f	%
Mild Sleep	18	60	2	6.7
Moderate Sleep	12	40	13	43.3
Deep Sleep	0	0	15	50

Fig: 2 Distribution of Pre test and Post test level of Sleep Score in the Experimental group

Table 2.shows that based on the duration of sleep cycle, the scores were classified under into 3groups. Mild sleep (0 - 2), moderate sleep (3 - 4), deep sleep (5 - 6) based on the Anders And Chalemian Sleep Scoring. In Pre test Deep sleep 0 (0%) moderate sleep 12 (40 %) and Mild sleep 18(60%). In Post test, Deep sleep 15(50%), moderate sleep 13(43.3%) and mild sleep 2(6.7%) in the experimental group.

Table 3: Frequency and percentage distribution according to the pretest and posttest levels of sleep score in the control group.

Sleep score	Control Group (n = 30)
	Pre test		Post test
	f	%	f	%
Mild sleep	21	70	19	63.3
Moderate sleep	9	30	11	36.7
Deep Sleep	0	0	0	0

Fig: 3 Distribution of Pre test and Post test level of Sleep Score in the Control group

Table 3 reveals that based on the sleep level scores obtained the subjects were classified into 3 groups, mild sleep (0-2), moderate sleep (3-4), deep sleep (5-6) based on the Anders And Chalemian Sleep Scoring (1974). In the pre test 21 (70%) had mild sleep, moderate sleep 9 (30%),Deep sleep, 0 (0%), and post test, mild sleep 19 (63.3%), moderate sleep 11 (36.7%) and0 (0%) deep sleep in the control group.

Table 4: Comparison of mean post test level of sleep score among newborns between the experimental and control group.(N = 60)

Group

Mean

S.D

‘t’ value

Experimental Group

Control Group

58.07

114.07

12.99

27.69

t = 10.03

p = 0.000

S***

Fig: 4. Comparison of post test level of sleep score among newborns between the experimental and control group

The above table shows, On comparison between the experimental and control group the posttest mean value of sleep score was 58.07 with S.D 12.99 in the experimental group and the posttest mean value of sleep score was 114.07 with S.D 27.69 in the control group. The calculated paired ‘t’ value of t = 10.03 was found to be statistically significant at p<0.05.

Table 5: The association between post level of sleep score with the selected demographic variables among the newborns in the experimental group

Demographic Variables	Sleep Score		χ2 Value
	Above mean	Below mean
Age:
a. 1 – 14 days	13	12	0.80 #
b. 14 - 28 days	2	3	(df=1)
Sex:
a. Male	14	6	4.91 *
b. Female	5	5	(df=1)
Weight:
a. < 2 kg	0	0	3.53 #
b. 2 – 3 kg	13	10	(df=2)
c. > 3 kg	4	3
Time of delivery:
a. Daytime	14	10	0.858 #
b. Night time	3	3	(df=1)
Mode / type of delivery :
a. Normal	14	10	30.02 *
b. Caesarean	4	2	(df=1)

The study conducted reveals that there was significant association between demographic variables such as sex and type/mode of delivery with the posttest level of sleep score in the experimental group. There was no significant association between demographic variables such as age, weight, time of delivery with the post test level of sleep score in the experimental group.

DISCUSSION:

It was found that swaddling techniques for the promotion of sleep pattern among newborn was effective in the experimental group. The newborns of the experimental group involved in the study slept well when compared to those newborns who were not swaddled in the control group.

CONCLUSION:

The study was conducted to find out if the swaddling technique is effective among newborns for the promotion of sleep pattern. On performing the research, the final outcome stated that the swaddling technique is found to be effective in promoting the sleep pattern of newborns when compared to the newborn babies those who were un swaddled in control group.

The mean post test sleep score of the experimental group significantly lower than the mean post test sleep score of the control group during the invasive procedure. There was no significant association between sleep score and age, weight, time of delivery. There was a significant association between score and sex and type/ mode of delivery.

Thus the research study concludes that the newborn who received the swaddling technique during the procedure has improved sleep pattern than the control group.

The following conclusions are drawn from the study.

1. Swaddling technique is more effective intervention to improve the level of sleep in newborns.

2. Swaddling helps to promote wellbeing and optimal growth of the newborn.

3. The experimental group newborns were experienced with more benefit.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The authors would like to thank Dr. L.P. Thangavelu, Chairman of Ashwin Hospital and Mrs. Shanthi Thangavelu, Correspondent of PPG Group of Institutions for their support and providing the facilities for the successful completion of the study.

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Received on 17.04.2023 Modified on 19.08.2023

A and V Pub Int. J. of Nursing and Medical Res. 2024; 3(1):1-5.

DOI: 10.52711/ijnmr.2024.01