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5 Evidence-Based Reasons to Advocate for Cycled Lighting in the NICU

5 Evidence-Based Reasons to Advocate for Cycled Lighting in the NICUCycled Lighting (lights on during the day and off at night) instead of constant bright light or irregular dim lighting has been widely studied and found to have developmental benefits for infants in the NICU. Therefore, The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists recommend neonatal care in a cycled lighting environment. While cycled lighting is standard in some NICUs, many still utilize constant bright or dim lighting. Depending on the specific architectural design and distinct culture of the NICU where you work, promoting cycled lighting practices may be challenging. To help equip you, here are five evidence-based reasons to advocate for cycled lighting:

1. Improved weight gain, shorter hospital stay, improved oxygen saturations, and more developed melatonin rhythm

A study published in the journal Early Human Development found the above benefits for preterm infants who were exposed to cycled lighting through the use of individual removable helmets versus constant lighting.

Vasquez-Ruiz, S., Maya-Barrios, J., Torres-Narvaez, P., Vega-Martinez, B., Rojas-Granados, A., Escobar, C., et al. (2014). A light/dark cycle in the NICU accelerates body weight gain and shortens time to discharge in preterm infants. Early Human Development, 90, 535-540.

2.  Reduced crying and fussing

Researchers at University Hospital Zurich examined the effects of cycled lighting versus irregular dim lighting on preterm infants at 5 and 11 weeks corrected age, and found that babies in the cycled lighting arm of the study spent significantly less time crying or fussing.

Guyer, C., Huber, R., Fontijn, J., Bucher, H., Nicolai, H., Werner, H., et al. (2012). Cycled light exposure reduces fussing and crying in very preterm infants. Pediatrics, 130(1), e145.

3. Trends towards lower incidence of retinopathy of prematurity and improved growth

A 2013 Cochrane review analyzed 6 studies on cycled lighting (including the study above). One study found that infants under cycled lighting had improved growth at 3 months of age. Many of the outcomes did not reach statistical significance, which researchers attribute to the small sample sizes in the studies. However, trends for most outcomes including weight gain, length of stay, time spent crying, and incidence of retinopathy of prematurity favor cycled lighting.

Morag, I., & Ohlsson, A. (2013). Cycled light in the intensive care unit for preterm and low birth weight infants. Cochrane Database of Systematic Reviews, 8.

4. Potential for increased adult anxiety-like responses in dim light environments

An animal study that found that mice exposed to dim light versus darkness at night in early life had increased anxiety responses later in life. While more research needs to be done on later outcomes of cycled lighting in humans, this study demonstrates the potential for worse outcomes under dim lighting conditions.

Borniger, J., McHenry, Z., Salloum, B., & Nelson, R. (2014). Exposure to dim light at night during early development increases adult anxiety-like responses. Physiology & Behavior, 133, 99-106.

5. Dim lighting in the NICU can potentially increase sleep disturbances in the family members of babies in the NICU.

Researchers who studied sleep in mothers of low birth weight infants found that these women had clinically significant sleep disturbances. The researchers posit that these women experience sleep disruption not only due to the stress of having a child in the NICU, but also due to exposure to artificial dim lights for extended periods, which can desynchronize circadian rhythms.

Lee, S., & Kimble, L. (2009). Impaired sleep and well-being in mothers with low-birth-weight infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(6), 676-685.