Abstract
BackgroundA multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome.MethodsTwo cohorts of preterm neonates born at < 32 weeks of gestational age, consecutively observed during 2 years, were compared prospectively before (Cohort 1: “conventional DR”) and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: “new concept of DR”). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software.ResultsWe enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9 ° C) was more frequent in Cohort 1 (57 %) compared with Cohort 2 (24 %, p = 0.001). Morbidity was increased in Cohort 1 (73 %) compared with Cohort 2 (44 %, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study.ConclusionsIf realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates.
Highlights
A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected
A multidisciplinary committee, consisting of a panel of experts including a member of Academy of Pediatrics (AAP) and American Institute of Architects (AIA), suggested a specific architectural design of the delivery room (DR) directly connected with neonatal intensive care unit (NICU) via a pass-through door, hypothesizing an improvement in the efficiency of preterm neonate stabilization procedures [3]
Care to neonates at birth is provided in area located within the DR and, only when necessary, after initial stabilization and a brief transportation, they continue in the NICU [4]
Summary
A multidisciplinary committee, consisting of a panel of experts including a member of AAP and AIA, suggested a specific architectural design of the delivery room (DR) directly connected with neonatal intensive care unit (NICU) via a pass-through door, hypothesizing an improvement in the efficiency of preterm neonate stabilization procedures [3]. The difficult stabilization process could be complicated by handling and moving in the first minutes of life [7,8,9] For these reasons, the construction of a DR directly connected via pass-through doors to the NICU appears a more appropriate strategy to meet the needs of neonates and to optimize human and economic resources. Starting from these considerations, we aimed to evaluate the impact of architectural DR and NICU renovation performed in accordance to predefined standards [3] on neonatal morbidity, mortality and hospitalization time
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