Room Neonatal Intensive Care Unit Research Articles

Stress and self-regulation behaviors in preterm neonates hospitalized at open-bay and single-family room Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) could be a risk factor for the development of preterm neonates due to the stressful procedures they undergo. Stress-related behaviors must be managed through environmental strategies that support regulating the neonates' biobehavioural system to minimize the negative impact on their development. The study aimed to compare the NICU environment's stressful procedures and developmental care strategies and the stress and self-regulation behaviors of preterm neonates in groups differentiated by the NICU environmental design. The sample comprised 20 preterm neonates hospitalized in a NICU with an open-bay model (OB NICU) and 20 preterm neonates hospitalized in a single-family room model (SFR NICU). The stressful procedures were assessed by the Neonatal Infant Stressor Scale (NISS). The developmental care strategies and the preterm neonates' stress and self-regulation behaviors were assessed using a structured observational protocol. The between-group comparison was performed by the Mann-Whitney test, and the significance level was set at 5%. Both NICUs had similar stressful procedures and developmental care approaches. However, the preterm neonates hospitalized in the SFR NICU exhibited significantly fewer total stress behaviors, and specifically in the motor system, compared to those in the OB NICU. Additionally, the preterm neonates hospitalized in the SFR NICU exhibited significantly more total self-regulation behaviors, and specifically in the behavioral state system, compared to those in the OB NICU. The findings showed that the single-family room NICU model was consistent with the environmental protection of biobehavioural regulation in preterm neonates hospitalized in the NICU.

Effect of Neonatal Intensive Care Unit (NICU) Humidity on Neonates: A Systematic Review.

This study explores the role of room humidity levels in the neonate intensive care unit (NICU) and how they impact their growth and development in this fragile stage. The study considers seven relevant studies that have explored this factor in different settings. Humidity's role in developing neonatal conditions, such as respiratory distress and fungal infections, is also elaborated on. For the literature review, the study utilized PubMed, Embase, and Scopusdatabases to guarantee comprehensive findings on the role of NICU room humidity on neonates. By examining these studies' evidence, the research highlights the paramount need to ensure that the room has adequate moisture, as exposure to less desirable humidity levels increases mortality and the severity of morbidity rates among neonates. The fact that the majority of NICUs lack humidity control, which is required, stimulated us to conduct this review.

QUALITATIVE EVALUATION OF ANTIBIOTIC USE IN THE NICU ROOM (NEONATE INTENSIVE CARE UNIT) IN HOSPITAL X CITY OF PADANG YEAR 2022

Neonates are very vulnerable to infection due to exposure to microorganisms during labor and sometime after birth. Some neonates need special care in the Neonatal Intensive Care Unit (NICU) room because of infection cases that require antibiotic therapy. This study aims to evaluate the use of antibiotics qualitatively. This study is an analytic descriptive study with cross sectional design, using retrospective data. Evaluation of antibiotic use qualitatively with the Gyssens method. While the relationship between the rationality of antibiotic use with the description of demographic and clinical characteristics of patients was analyzed by chi square. The source of data was the medical records of patients admitted to the NICU room of Hospital X in Padang City who were admitted from January 1, 2022 to December 31, 2022. Descriptive analysis was performed to determine the description of demographic and clinical characteristics of patients and evaluation of antibiotic use. From this study, the results of qualitative evaluation obtained category 0 (rational) 180 (71.14%), category IIa as many as 14 (5.53%), category IIb as many as 9 (3.56%), category IIIa as many as 21 (8.30%) and category IIIb as many as 28 (11.07%).The relationship between the accuracy of antibiotic use with the description of demographic characteristics and NICU discharge conditions obtained the results there is a difference in the level of accuracy of antibiotic use with the birth process (p=0.000) and there is a difference in the level of accuracy of antibiotic use with NICU discharge conditions (p=0.000).

Music therapy intervention in an open-bay neonatal intensive care unit room is associated with less noise and higher signals: A case-control study

Music therapy intervention in an open-bay neonatal intensive care unit room is associated with less noise and higher signals: A case-control study

Examining Efficiency in Open-Bay and Single-Family Room NICU Designs.

There is growing awareness of the relationship between physical work environments and efficiency. Two conflicting factors shape efficiency in the neonatal intensive care unit (NICU) environment: the move to single-family rooms (SFRs) and increased demand for care, requiring growth in unit size. The goal of this research was to understand the impact of SFR NICUs on efficiency factors such as unit design, visibility and proximity, staff time, and workspace usage by various health professionals. A pre-/postoccupancy evaluation assessed a NICU moving from an open-bay to an SFR unit composed of 6 neighborhoods. A NICU patient care manager and researchers in design and communication implemented a multimethodological design using staff surveys, observations, and focus groups. Outcomes revealed SFR NICUs contribute to increased efficiency and overall satisfaction with design. Outside of staff time spent in patient rooms, decentralized nurse stations were the most frequented location for staff work, followed by huddle stations, medication and supply rooms, and corridors. Work at the observed locations was largely performed independently. Survey outcomes reported increased feelings of isolation, but focus groups revealed mixed opinions regarding these concerns. Design solutions found to enhance efficiency include a neighborhood unit design, standardized access to medications and supplies, and proximity of supplies, patient rooms, and nurse workstations. Although feelings of isolation were reported and most staff work was done independently in the patient room, the SFR unit might not be the culprit when considered alongside staff's desire to be closer to the patient room.

The seven points of developmental care for preterm neonates: Nurses’ knowledge and attitudes in the NICU Room

Preterm neonates (premature infants) are born with various risks that require them to be admitted to the Neonatal Intensive Care Unit (NICU) which is full of stressors. The impact of stressors in the NICU on infants can be minimized by the provision of seven points of developmental care. Unfortunately, the NICU nurses’ knowledge and attitude in implementing the seven points of developmental care was still lacking, that not all nurses did. This study aims to identify the effect of education on the seven points of developmental care in increasing the NICU nurses’ knowledge and attitude. The pre-experimental research design of one group pretest-posttest was chosen, involving 28 NICU nurses who were selected by using simple random sampling technique. The inclusion criteria of respondents included nurses with more than 1 year of work experience. Education was given 3 times with a duration of 2 hours through online videos. Data were analyzed using the Wilcoxon test. There was a significant increase in knowledge and attitudes on the aspects of stress cues (p= 0.025), principles of cooperation with family (p=0.003), Standard Operating Procedure (SOP) of Cooperation with family (p= 0.012), Infant Positioning Assessment Tool (p= 0.003), minimizing pain by touching (p=0.002), route of providing nutrition (p= <0.001), and non-nutritive sucking p= 0.004). Education on the seven points of developmental care is able to increase the NICU nurses’ knowledge and attitudes in implementing interventions for preterm neonates. The provision of education is required regularly in order to refresh and update information for the NICU nurses so that they are able to provide appropriate, optimal, and up-to-date care for preterm neonates.

Perawatan Stoma pada Bayi dengan Malformasi Anorektal Letak Tinggi tanpa Fistula di Ruang Neonatal Intensive Care Unit : Studi Kasus

Anorectal malformation without fistula is a congenital disorder that requires a colostomy. Stoma care is very important to prevent infection in neonates, with good care it is hoped that there will be no damage to the integrity of the skin area around the stoma.
 This study was to report changes in skin color around the stoma in infants with high anorectal malformations without fistulas in the Neonatal Intensive Care Unit (NICU) after stoma treatment.
 Using a case study design by describing the nursing care given to baby S with a gestational age of 38 weeks in a level III A NICU room at Dr. Wahidin Sudirohusodo Hospital Makassar. Data were collected through observation and documentation of stoma care twice at an 8-day interval. Presentation of data using narrative in explaining the results obtained from case studies
 After the stoma treatment, the skin color appears reddish, and there is no necrotic. Interventions performed on infants with colostomy are stoma care to prevent damage to skin integrity. On were the first observation before the stoma treatment, the skin color around the stoma was brownish and there was necrotic then, after the stoma treatment, the skin color appeared reddish, there was no necrotic.
 In conclusion, changes in the skin color of the area around the stoma improved after treatment, the patient's stoma appeared to change from brown and there was necrotic to reddish color and no necrotic.

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study.

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). Study design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.

Respiratory status and behavioral response of premature infant with nesting model care approach in neonatal intensive care unit

Introduction: The increase in mortality of newborns, especially premature babies, is caused by non-optimal lung development where the production of less surfactant triggers lung collapse and compliance. This causes stress on the newborn and requires more intensive care. One of the care taken to overcome these problems is the nesting application. Objectives: To identify the effect of nesting model care on premature infants' respiratory status and behavioral responses. Methods: This study is a quasi-experimental design with a pre-post-test group design. The samples were premature infants admitted to the Neonatal Intensive Care Unit (NICU), with as many as 40 respondents. The sampling technique is purposive sampling. Data were analyzed using the Mann-Whitney test and Wilcoxon test. Results: The results showed no significant differences between the respiratory status in modern and conventional nesting, with P-value = 0.292. While there was a significant difference in behavioral responses, both groups with P = 0.027. There was an effect on respiratory status before and after nesting in the modern nesting group where the significance P = 0.001 and no effect in the conventional nesting group with a P value = 0066. Regarding behavioral responses, there was a significant value in two of the group before and after nesting, where the value significance respectively P = 0.009 and P = 0.025. Conclusions: Modern nesting influences scores and behavioral responses in premature infants, while conventional nesting only affects reducing the score of behavioral responses. It is expected that the use of nesting in the NICU room specifically for premature babies prefers the use of modern nesting compared to conventional nesting babies to maintain stability in terms of both respiratory and response behavior.

Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement.

Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia. This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement. The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort. After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004). Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement. Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures.

Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project.

The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.

Noise Level and its Sources in Neonatal Intensive Care Units of Selected Public Hospitals in Kigali City

Background
 Noise in the neonatal intensive care unit (NICU) has an impact on the developmental progress of neonates, especially preterm. Technology advancement has improved the life of preterm neonates, but also changed NICU into a noisy place.
 Objective
 To measure the noise levels and identify its sources in NICU at selected public hospitals in Kigali city`
 Methods
 A quantitative cross-sectional descriptive study. A sound level meter was used in recording the Sound level in six different locations of the NICUs at five different times. An observational checklist was used to identify possible sources of noise. Data were analysed using descriptive and inferential statistics (ANOVA).
 Results
 Sound levels recorded in all the NICUs were high ranging from 61.8 decibel (dB) to 77.0 dB, greater than the 45 dB recommended by the American Association of Pediatrics (AAP). The maximum noise level was 77.0 dB. Ward rounds had the highest noise levels, and lunchtime had the lowest noise levels in all hospitals. Noise levels were high at the station near the entrance in all NICU rooms.
 Conclusion
 In all NICUs, the noise level generated was greater than the standard limits established by AAP. Neonates need noise-free environment as excess noise has an impact on their wellbeing.
 Rwanda J Med Health Sci 2020;3(2):115-127

Human-centered design strategies in family and staff preparation for neonatal care.

This paper describes human-centered design strategies used to develop solutions for neonatal intensive care unit (NICU) patients, families, and staff in preparation for transition from an open bay (OB) NICU to a single-family room (SFR) NICU. Through a series of user group meetings, an interdisciplinary team of NICU families, administrators, providers, nurses, and other care team members (CTMs) collaborated with design professionals to create and carry out their vision for the new NICU. This process, which spanned the design, construction, and transition planning phases of the project, enabled stakeholders at the Medical University of South Carolina in Charleston, South Carolina (USA) to seek solutions for integrating patient and family-centered care into the fabric of its new facility and to redesign the care experience. From this work, new opportunities for family and staff engagement emerged. Continuous end-user involvement led to targeted preparation for neonatal care.

Comparison Results of Automated Auditory Brainstem Response and Brainstem Evoked Response Audiometry for Hearing Loss Detection in High-risk Infants

BACKGROUND: Brainstem evoked response audiometry (BERA) is not widely used for hearing screening because it is considered less practical; however, it is often used for diagnostics. Since the founding of automated auditory brainstem response (AABR), it often uses because it is more practical, has a high sensitivity and specificity in early detection of hearing loss (HL) in high-risk infants.
 AIM: The objective of the study was to determine the differences results of AABR and BERA for HL detection in high-risk infants at neonatal intensive care unit (NICU).
 METHODS: The study was conducted from November 2014 to September 2015 with consecutive sampling. The subjects were high-risk infants treated in the NICU room of the Neonatology Division at Dr. Soetomo General Hospital Surabaya and examined using AABR or BERA to determine the existence of HL.
 RESULTS: BERA results obtained normal (negative) as many as 28 ears (73.68%) and not normal (positive) as many as 10 ears (26.32%). AABR results obtained pass (negative) as many as 23 ears (60.53%) and refer (positive) as many as 15 ears (39.47%). Detection of HL in high-risk infants in NICU with AABR obtained 40% of sensitivity and 60.71% of specificity, 26.67% of positive prediction (NPP), 73.91% of negative predictive value (NPN), 55.26% of accuracy, 39.29% of false positive error rate, and 60% of false negative error rate. The comparative test of Wilcoxon signed-rank between the results of AABR and BER obtained p = 0.236.
 CONCLUSIONS: There was no difference between AABR and BERA results for HL detection in high-risk infants at NICU.

Single-centre prospective observational study on postdelivery room care

ObjectivesAs quality of care in the delivery room has major impact on outcome of preterm infants, multiple guidelines have been established in recent years. There is, however, little evidence on...

Characterizing the acoustic environment in a Neonatal Intensive Care Unit

In this work, noise sources were studied in a Neonatal Intensive Care Unit (NICU) by evaluating the noise from various sources, including the influence of the work of the NICU staff. The objective was to evaluate the acoustic quality in the usual conditions in NICU rooms and inside incubators by monitoring the noise in both environments, and then data were processed using artificial neural networks. Although some types of noise were accurately classified in this way, the lack of uniformity of their sound spectra, their simultaneity, and concomitance hindered the unequivocal interpretation of some results with the classification models. After analyzing the results, it can be affirmed that the alarms of equipment had a remarkable influence on the acoustic environment. Other important influences also appeared due to the conversations of the staff, the use of the telephone, and the hauling of equipment and furniture.

Single-family room neonatal intensive care unit design: do patient outcomes actually change?

This study examined outcomes in a single-family room neonatal intensive care unit (NICU) compared to an open bay within a public safety net hospital. We included 9995 NICU encounters over 5 years pre and post move for a predominantly low SES population. Outcomes were length of stay (LOS), growth, time to first oral feeding, and incidence of sepsis. Analysis included regression models, interrupted time series, and growth models. LOS decreased over time in preterm infants both pre and post move, but increased post move for term/post-term infants (p < 0.001). First oral feeding decreased over time in both periods. A higher incidence of sepsis was found in the post period for term/post-term infants (p = 0.01). Our analysis appropriately accounted for time trends. Few differences were observed. Changes in LOS for term/post-term infants should be further explored as well as the impact of NICU care patterns.

Journey to mother baby care: Implementation of a combined care/couplet model in a Level 2 neonatal intensive care unit.

"Why can't I have my postpartum care in the same room as my baby?" questioned Hilary, a neonatal intensive care unit (NICU) "alumni" parent, during a design event for the new British Columbia's Women's Hospital 70 single family room NICU. This simple yet provocative question was nearly dismissed and the idea of a combined care model lost, since most members of the team thought it was simply "not possible." Hilary did not give up and continued to raise this idea throughout every design event. It was Hilary's fortitude and sharing of her NICU experience that was the inspiration for the MotherBaby Care unit. The voice of one woman has improved the birth experiences of potentially thousands of mothers and their at-risk newborns. By honoring women's voices and values in health care, positive changes that matter to women, infants, and families can be made. Mothers also shared: "I knew what was best for me was to be with my baby," "If I could stand up after my C-section, I would drag my IV pole to be with my baby!", "Teach me how to take care of my premature baby before I am ready to go home!" MotherBaby Care is a combined care or "couplet" care where one NICU nurse provides care for a postpartum mother and her at-risk newborn in the Level 2 NICU. This review describes the journey from innovation and design to the implementation of the MotherBaby Care model.

Comparison of Infant Gut and Skin Microbiota, Resistome and Virulome Between Neonatal Intensive Care Unit (NICU) Environments.

Background: There is a growing move to provide care for premature infants in a single family, private room neonatal intensive care unit (NICU) in place of the traditional shared space, open bay NICU. The resultant effect on the developing neonatal microbiota is unknown.Study Design: Stool and groin skin swabs were collected from infants in a shared-space NICU (old NICU) and a single-family room NICU (new NICU) on the same hospital campus. Metagenomic sequencing was performed and data analyzed by CosmosID bioinformatics software package.Results: There were no significant differences between the cohorts in gestational age, length of stay, and delivery mode; infants in the old NICU received significantly more antibiotics (p = 0.03). Differentially abundant antimicrobial resistance genes and virulence associated genes were found between the cohorts in stool and skin, with more differentially abundant antimicrobial resistance genes in the new NICU. The entire bacterial microbiota analyzed to the genus level significantly differed between cohorts in skin (p = 0.0001) but not in stool samples. There was no difference in alpha diversity between the two cohorts. DNA viruses and fungi were detected but did not differ between cohorts.Conclusion: Differences were seen in the resistome and virulome between the two cohorts with more differentially abundant antimicrobial resistance genes in the new NICU. This highlights the influence that different NICU environments can have on the neonatal microbiota. Whether the differences were due to the new NICU being a single-family NICU or located in a newly constructed building warrants exploration. Long term health outcomes from the differences observed must be followed longitudinally.

The developing premature infant gut microbiome is a major factor shaping the microbiome of neonatal intensive care unit rooms

BackgroundThe neonatal intensive care unit (NICU) contains a unique cohort of patients with underdeveloped immune systems and nascent microbiome communities. Patients often spend several months in the same room, and it has been previously shown that the gut microbiomes of these infants often resemble the microbes found in the NICU. Little is known, however, about the identity, persistence, and absolute abundance of NICU room-associated bacteria over long stretches of time. Here, we couple droplet digital PCR (ddPCR), 16S rRNA gene surveys, and recently published metagenomics data from infant gut samples to infer the extent to which the NICU microbiome is shaped by its room occupants.ResultsOver 2832 swabs, wipes, and air samples were collected from 16 private-style NICU rooms housing very low birth weight (< 1500 g), premature (< 31 weeks’ gestation) infants. For each infant, room samples were collected daily, Monday through Friday, for 1 month. The first samples from the first infant and the last samples from the last infant were collected 383 days apart. Twenty-two NICU locations spanning room surfaces, hands, electronics, sink basins, and air were collected. Results point to an incredibly simple room community where 5–10 taxa, mostly skin-associated, account for over 50% of the amplicon reads. Biomass estimates reveal four to five orders of magnitude difference between the least to the most dense microbial communities, air, and sink basins, respectively. Biomass trends from bioaerosol samples and petri dish dust collectors suggest occupancy to be a main driver of suspended biological particles within the NICU. Using a machine learning algorithm to classify the origin of room samples, we show that each room has a unique microbial fingerprint. Several important taxa driving this model were dominant gut colonizers of infants housed within each room.ConclusionsDespite regular cleaning of hospital surfaces, bacterial biomass was detectable at varying densities. A room-specific microbiome signature was detected, suggesting microbes seeding NICU surfaces are sourced from reservoirs within the room and that these reservoirs contain actively dividing cells. Collectively, the data suggests that hospitalized infants, in combination with their caregivers, shape the microbiome of NICU rooms.