# Influence of Sensory Needs on Sleep and Neurodevelopmental Care in At-Risk Neonates

## TL;DR

This paper explores how sensory needs and environmental factors affect sleep and development in high-risk newborns, emphasizing the need for better evidence and systemic changes in care practices.

## Contribution

The paper highlights the lack of evidence on optimal lighting and noise reduction in neonatal care and advocates for randomized trials to improve neurodevelopmental outcomes.

## Key findings

- There is extensive literature on fetal and neonatal sensory development but limited evidence on optimal lighting and noise reduction measures.
- The WHO recommends skin-to-skin contact from birth to support early bonding and developmental care.
- Systemic changes in obstetric and neonatal settings are needed to improve perinatal management and neonatal intensive care.

## Abstract

Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and high noise levels. In high-risk newborns, this process can be influenced by immaturity of the central and peripheral nervous systems, therapeutic strategies and the work organization of an intensive care unit. Methods: This study used a narrative review to examine the literature on the interrelationship of sensory modalities on sleep–wake behavior in the context of neonatal intensive care. The current Cochrane reviews on cycled lighting’s effect on premature infants’ circadian rhythm development and noise or sound management in the neonatal intensive care unit, as well as the World Health Organization (WHO) global position paper on kangaroo mother care, were included. Results: An extensive body of literature relates to fetal and neonatal development of the five sensory modalities: touch, taste, smell, hearing and sight. In contrast, there is a lack of evidence regarding the choice of optimal lighting and suitable measures for noise reduction. Since 2023, the WHO has recommended that, from the moment of birth, every “small and sick” newborn should remain in skin-to-skin contact (SSC) with their mother. Developmental support pursues a multimodal approach with the goal of fostering early parent–child bonding, including the child’s needs and environmental conditions. Discussion: The implementation of early SSC and attention to the sleep–wake cycle require systemic changes in both the obstetric and neonatal settings to ensure seamless perinatal management and subsequent neonatal intensive care. Since there is a lack of evidence on the optimal sensory environment, well-designed, well-conducted and fully reported randomized controlled trials are needed that analyze short-term effects and long-term neurodevelopmental outcomes.