Neonatal Intensive Care Unit Design and its Effect on Infant Health and Development and Parent Psychosocial Health

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BACKGROUND: In the past four decades, there has been an increasing interest in designing neonatal intensive care units (NICUs) to create a healing environment with beneficial effects on the caregiving process, health and development of infants, and family comfort. However, the effects of single-family rooms (SFRs) on infant and parental outcomes, parental involvement, and hospital length of stay remain unclear. METHODS: We conducted a systematic review comparing NICU design and its influence on infants’ health and development up to 2 years of age. We searched MEDLINE, CINAHL, Embase, Cochrane Central, Scopus, Web of Science with English language limitations and no time limit. In addition, we conducted a review of reviews. RESULTS: SFRs were associated with increased parental presence, earlier initiation and longer duration of skin-to-skin care, more frequent infant caregiving activities, greater sustained exclusive breastfeeding up to 4 months corrected age, and reduced overall direct care costs. Infants had earlier experience with their mother's milk and oral feeding. Differences in infant rate of weight gain and weight at discharge were mediated by increased maternal involvement and developmental support. In SFRs, parents reported more privacy, greater comfort, satisfaction with family centered care, and a sense of control/ownership. Increased opportunity to participate in rounds and shared decision made them feel more emotionally supported. Parental stress results were mixed; however, parents reported less stress related to sights and sounds with SFRs. In SFRs versus open designs, length of stay ranged from 4 days longer to 3.4 to 15 days shorter. Regardless of NICU design, infant stress, pain, medical procedures, and infant attention were mediated by increased maternal involvement. Maternal involvement and greater human milk feeding were associated with a decreased length of stay irrespective of NICU design. Skin to skin care and maternal care, but not NICU design, were the most significant predictors of neurodevelopmental at 18 months. CONCLUSION: NICU designs and policies that facilitate parental presence benefit everyone. Consistent with family integrated care, parents need to feel welcomed and supported to be present. An environment that addresses the medical, developmental, educational, emotional, and social needs of the infants, families, and staff is essential for improved outcomes.
Video Recording (29 minutes) - Michelle Clapperton Master of Nursing Capstone Presentation. Supervisory Committee: Drs. Karen Benzies, Debbie McNeil, and K. Alix Hayden
neonatal intensive care units, neonatal care, NICU design, single family room
Clapperton, M. (2022). Neonatal Intensive Care Unit Design and its Effect on Infant Health and Development and Parent Psychosocial Health (Unpublished master's project). University of Calgary, Calgary, AB.