A Comprehensive Comparison of Open-Bay and Single-Family-Room                     Neonatal Intensive Care Units at Sanford Children's Hospital

Stevens, Dennis C.; Helseth, Carol C; Thompson, Paul A.; Pottala, James V.; Khan, Mohammad Akram; Munson, David P.

doi:10.1177/193758671200500403

Cited by 51 publications

(65 citation statements)

References 36 publications

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“…3 Further, current recommendations for NICU design include construction of private space to reduce environmental stimulation to the infant and support family involvement. 8 Positive staff and caregiver perceptions, 9-11 decreased noise levels and nosocomial infections, 12, 13 and lower rates of readmission in the months after discharge 14 were reported following NICU renovation to private rooms. A randomized clinical trial conducted in Sweden reported reductions in length of stay among infants assigned to single family rooms, consisting of private space for the family and infant, and in which parents were required to be present from admission to discharge.…”

mentioning

confidence: 99%

Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Pineda

Neil

Dierker

et al. 2014

The Journal of Pediatrics

293

225

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Objective To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology and brain structure at hospital discharge; and developmental outcomes at two years of age. Study design In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at two years of age (n=86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were 1) medical factors throughout the hospitalization, 2) neurobehavior, and 3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography). Results At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores [p= 0.02; β=−0.52 (CI −0.95, −0.10)]. At age two years, infants from private rooms had lower language scores [p= 0.006; β=−8.3 (CI −14.2, −2.4)] and a trend toward lower motor scores [p= 0.02; β=−6.3 (CI −11.7, −0.99)], which persisted after adjustment for potential confounders. Conclusion These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.

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confidence: 99%

Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Pineda

Neil

Dierker

et al. 2014

The Journal of Pediatrics

293

225

View full text Add to dashboard Cite

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“…[8][9][10][11] Some of these inconsistencies could be due to methodologic issues. of NICU may be inadequate to explain potential differences, be they positive or negative, and that it is critical to study why such differences are observed.…”

Section: Figurementioning

confidence: 99%

“…These include a shorter interval until full enteric feedings; fewer apneic events; reductions in mortality, nosocomial sepsis, 2 length of stay, [3][4][5] rehospitalization, 4 cost, 6 and noise; increases in breastfeeding, 2 family-centered care, parent visitation, privacy and satisfaction 3,[6][7][8] ; more positive staff perceptions of the environment 2 and job quality 9 and less nurse anxiety. 10 However, negative effects have also been reported including increased number of staff, 10 poorer quality of staff interaction, 9,11 and increased maternal stress. 8 Alterations in brain structure and function have also been reported among infants in private NICU rooms in a NICU with poor family involvement.…”

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confidence: 99%

Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:The single-family room (SFR) NICU is a major response to improve care and reduce developmental morbidity in preterm infants. However, no studies have examined how and why this model is associated with changes in medical and neurobehavioral outcome. WHAT THIS STUDY ADDS:This study shows improved medical and neurodevelopmental outcome in infants hospitalized in the SFR model of care. More important, improvements occurred specifically in relation to increases in maternal involvement and developmental support afforded by the SFR environment. abstract OBJECTIVE: To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes. METHODS:Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born ,1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU. Structural equation modeling was used to determine the role of mediators of relations between type of NICU and medical and neurobehavioral outcomes. RESULTS:Statistically significant results (all Ps #.05) showed that infants in the SFR NICU weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, had a lower gestational age at full enteral feed and less sepsis, showed better attention, less physiologic stress, less hypertonicity, less lethargy, and less pain. NICU differences in weight at discharge, and rate of weight gain were mediated by increased developmental support; differences in number of medical procedures were mediated by increased maternal involvement. NICU differences in attention were mediated by increased developmental support. Differences in stress and pain were mediated by maternal involvement. Nurses reported a more positive work environment and attitudes in the SFR NICU. CONCLUSIONS:The SFR is associated with improved neurobehavioral and medical outcomes. These improvements are related to increased developmental support and maternal involvement. Pediatrics 2014;134:754-760

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“…The noise level is higher in multibed than single-bed rooms (8,10,18), and noise increases subjective stress, annoyance, sympathetic nervous system activation (19), and sleep disruption (8). It has been proved that sleep disruption and the consequent deprivation are associated with an increase in delirium prevalence (20) and confirming that association, the use of ear plugs during the night decreases the delirium prevalence in ICU patients (21).…”

Section: Hypotheses For the Difference In Delirium Prevalencementioning

confidence: 87%

ICU Architectural Design Affects the Delirium Prevalence

Caruso¹,

Guardian²,

Tiengo³

et al. 2014

Critical Care Medicine

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A Comprehensive Comparison of Open-Bay and Single-Family-Room Neonatal Intensive Care Units at Sanford Children's Hospital

Abstract: These data overwhelmingly support the SFR NICU in preference to the traditional OPBY facility. They substantiate that the SFR NICU should be the new standard for NICU care.

Cited by 51 publications

References 36 publications

Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Alterations in Brain Structure and Neurodevelopmental Outcome in Preterm Infants Hospitalized in Different Neonatal Intensive Care Unit Environments

Single-Family Room Care and Neurobehavioral and Medical Outcomes in Preterm Infants

ICU Architectural Design Affects the Delirium Prevalence

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